Surgical device for stapling and/or fastening body tissues

ABSTRACT

A surgical device for stapling and fastening body tissues, comprises an insertion section extending from an operation section for insertion into a body cavity, stapling member connected to a distal end of the insertion section, for treating body tissues with a high-frequency current within a body cavity. The stapling member includes an anvil and a cartridge between which the tissues are sandwiched, and a cutter. Staples are applied to the anvil from the cartridge for stapling the tissues and the cutter cuts the tissue while it applies a high-frequency current thereto.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a surgical device for stapling and/orfastening body tissues.

2. Description of the Related Art

To remove a gallstone or gallstones from the gallbladder, for example,the gallbladder needs to be extracted in order to prevent the forming ofother stones. To extract the gallbladder, it is necessary to cut thejunction between the gallbladder and the bile duct. Extending throughthis junction are bile arteries and the bile duct. Hence, to extract thegallbladder without damaging the same, the bile duct must be cut with aknife or the like and must be stapled immediately.

Various staplers are known which are designed for use ingallstone-removing procedures. Any of these staplers is inserted throughan incision made in the abdominal wall into the body cavity where thegallbladder is located. The stapler is manipulated to apply staples tothe body tissues, thereby to fasten them together. Some staplers of thistype are disclosed in, for example, Published Examined Japanese Utilitymode Applications Nos. 38-19282 and 60-41924 and Publish UnexaminedJapanese Patent Application No. 3-12126.

The stapler disclosed in Published Examined Japanese Utility ModelApplication No. 38-19282 is designed for stapling the stomach. Thestapler comprises a staple holder and an anvil. The staple holdercontains staples and has a staple-feeding mechanism. Both the stapleholder and the anvil curve in the same way as the stomach does. Thestaple holder is rotatably hinged to the anvil by a pin.

The stapler disclosed in Published Examined Japanese Utility ModelApplication No. 60-41924 is designed to staple a cancerous tumor. Thisstapler comprises a scissors-like stapling body. The stapling body isslender, consisting of a grip and a staple-holding section. Thestaple-holding section comprises a staple holder and an anvil which arehinged together at one end. Both the staple holder and the anvil curvein the same way as the cancerous organ does, and constitute abeak-shaped unit while placed in their closed positions.

The stapler disclosed in Published Unexamined Japanese PatentApplication No. 3-12126 is designed to staple together body tissueslocated within a body cavity. This stapler comprises an insertionsection, a stapling member, a firing handle and an operating handle. Thestapling member is connected to the distal end of the insertion sectionand comprises an anvil and a cartridge. The cartridge is rotatablyconnected to the anvil and used to contain staples. The firing handle iscoupled to the proximal end of the insertion section; it is squeezed toeject a staple from the cartridge. The operating handle is connected tothe proximal end of the insertion section, too; it is operated to openand close the stapling member.

The stapler disclosed in Published Examined Japanese Utility ModelApplication No. 38-19282 has no insertion section, and cannot beinserted into a body cavity through an incision made in a body wall.Since the staple holder has no means for cutting the body tissuesstapled together, a separate cutting instrument must be used to cut thebody tissues.

When the stapler disclosed in Published Examined Japanese Utility ModelApplication No. 60-41924 is employed, it is necessary to incise a bodywall (e.g., the abdominal wall, the chest wall, or the like) so that theinsertion section may be inserted into a body cavity, giving rise togreat attacks. Further, since the stapler has no means for cutting thebody tissues stapled together, a separate cutting instrument must beused to cut the body tissues.

The stapling member of the stapler disclosed in Published UnexaminedJapanese Patent Application No. 3-12126 is straight, axially alignedwith the insertion section. If there is a conglutination in the bodycavity, narrowing the cavity, it would be difficult to move theinsertion section to the target body tissues. Further, if the targettissues are located away from the axis of the insertion section, aforceps or the like must be inserted into the body cavity to hold andplace the tissues on the axis of the insertion section.

As described above, the conventional staplers have but low operability,requiring other surgical instruments to perform surgical operations.When they are used, it usually take a long time to complete theoperations, causing much pain and toil on the part of the patient. Noneof the conventional staplers cannot perfectly stop the flow of blood orother body fluid from the body tissues after the tissues have beensevered and stapled. There are two reasons for this. First, a gapremains between the anvil and the staple holder (or the cartridge) evenwhen they are set in their closed positions. Second, a single clip orstaple applied to body tissues to stop bleeding gets loose due to theforce which the tissues exert on the clip or staple as they restoretheir shapes.

Generally, any bleeding tissues or organs, whether fastened or not withclips or staples, are solidified by means of an electric knife or thelike, thereby stopping the bleeding. During endoscopic procedures,however, it is cumbersome for surgeons to remove the stapler or the clipapplicator from the distal end of the endoscope and then to attach theelectric-knife electrode.

SUMMARY OF THE INVENTION

The object of the present invention is to provide a surgical devicewhich is inserted into a body cavity through an incision made in a bodywall, for stapling, fastening, and cutting the body tissues located inthe cavity, and which can reliably stop the bleeding at the stapled orfastened tissues, helping to shorten the time of a surgical operation.

Additional objects and advantages of the invention will be set forth inthe description which follows, and in part will be obvious from thedescription, or may be learned by practice of the invention. The objectsand advantages of the invention may be realized and obtained by means ofthe instrumentalities and combinations particularly pointed out in theappended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate presently preferred embodiments ofthe invention and, together with the general description given above andthe detailed description of the preferred embodiments given below, serveto explain the principles of the invention.

FIG. 1 is a perspective view of a surgical stapler according to a firstembodiment of this invention;

FIG. 2 is an exploded view showing the stapler illustrated in FIG. 1;

FIG. 3 is an enlarged view showing the distal end portion of theinsertion section of the stapler;

FIG. 4 is a cutaway perspective view showing the stapling member of thestapler and also the distal end portion of the insertion sectionthereof;

FIG. 5 is a sectional side view of the distal end portion of theinsertion section, illustrating the stapling member in its closedposition;

FIG. 6 is a sectional side view of the distal end portion of theinsertion section, illustrating the stapling member in its openposition;

FIG. 7 is a cross-sectional view of the distal end portion of theinsertion section;

FIG. 8 is a sectional side view showing a part of the stapling member;

FIG. 9 is a diagram explaining how stitch body tissues together by meansof the surgical stapler shown in FIG. 1;

FIG. 10 is a diagram showing the body tissues stitched together;

FIG. 11 is a perspective view showing the stapling system comprising thestapler and a high-frequency cautery device;

FIG. 12 is a cutaway side view showing the operation section of thestapler;

FIG. 13 is a sectional side view of the cartridge, illustrating modifiedpusher plates;

FIG. 14 is a side view of the modified pusher plates;

FIG. 15 is a sectional view showing the tissues stapled together by thestapler incorporating the modified pusher plates;

FIG. 16 is a side view showing another modified pusher plate;

FIG. 17A is a plan view showing the cartridge of a modified staplingmember;

FIG. 17B is a cross-sectional view of the cartridge, taken along line17B--17B in FIG. 17A;

FIG. 17C is a partly cutaway side view of the cartridge;

FIGS. 18A and 18B are a side view and plan view of the anvil of themodified stapling member;

FIG. 19 is a perspective view of a stapler incorporating the modifiedstapling member;

FIGS. 20A and 20B are a side view and front view showing the modifiedstapling member;

FIG. 21 is a plan view showing the anvil of another modification of thestapling member;

FIG. 22 is a perspective view showing staples applied by the staplingmember shown in FIG. 21, stitching body tissues together;

FIG. 23 is a plan view showing the staples applied by the staplingmember shown in FIG. 21;

FIG. 24A is a perspective view showing a modified staple applied by astapler according to the invention;

FIG. 24B is a plan view showing a row of staples identical to the stapleshown in FIG. 24A;

FIG. 25A is a perspective view showing another modified staple appliedby a stapler according to the invention;

FIG. 25B is a plan view showing a row of the staples identical to thestaple shown in FIG. 25A;

FIG. 26A is a perspective view showing still another modified stapleapplied by a stapler according to the invention; FIG. 26B is a plan viewshowing a row of the staples identical to the staple shown in FIG. 26A;

FIG. 27A is a plan view of one of identical grooves formed in the innersurface of an anvil, each for bending the tips of a staple, and FIG. 27Bis a plan view of a staple with its tips bent along the groove;

FIG. 28A is a plan view of one of identical grooves formed in the innersurface of an anvil, each for bending the tips of a staple, and FIG. 28Bis a plan view of a staple with its tips bent along the groove;

FIG. 29 is a perspective view of a stapler according to a secondembodiment of the present invention;

FIG. 30 is a sectional side view of the stapling section of theinsertion section of the stapler, explaining how staples are loaded intothe stapling section;

FIG. 31 is a sectional side view of the stapling section, explaining howeach staple is deformed to fasten body tissues together;

FIG. 32 is a front view of the stapling section of the secondembodiment;

FIG. 33 is an exploded view showing the stapling section;

FIG. 34 is a sectional side view of the stapling section;

FIGS. 35A, 35B and 35C are diagrams explaining how the stapler appliesstaples to stitch body tissues together;

FIGS. 36A and 36B are sectional side views of the distal end portion ofa modification of the stapler according to the second embodiment, FIG.36A showing the hollow cylindrical cover pulled to its retreatedposition, and FIG. 36B showing the cover thrust to its forward position;

FIG. 37 is a perspective view showing the modification of the stapler;

FIG. 38 is a sectional side view showing a part of the operation sectionof the modification of the stapler;

FIGS. 39A, 39B, and 39C are diagrams explaining how a modified stylusserves to stitch a wound;

FIGS. 40A and 40B are diagrams explaining how a modified stylus is used;

FIG. 41 is a perspective view of a modified insertion section having twostyluses protruding from the distal-end face;

FIGS. 42A, 42B, and 42C are diagrams showing another modified insertionsection having a suction tube, and explaining how the tube is used toclose a wound;

FIGS. 43A, 43B, and 43C are diagrams showing still another modifiedinsertion section having a scoop-like member protruding from thedistal-end face, and explaining how the scoop-shaped member is used toclose a wound;

FIG. 44 is an exploded view of the insertion section of a stapleraccording to a third embodiment of the present invention;

FIG. 45A is a sectional side view of the insertion section, showing howthe stapler is operated to deform a staple;

FIG. 45B is a sectional side view of the insertion section, showing howthe stapler is operated to load staples;

FIG. 45C is a front view of the insertion section;

FIG. 46 is a sectional side view of the stapler according to the thirdembodiment;

FIG. 47 is a perspective view showing the hollow cylindrical pusher andswitching member, both incorporated in the operation section of thestapler;

FIG. 48A is a cross-sectional view, taken along line 48A--48A in FIG.46; FIG. 48B is a across-sectional view, taken along line 48B--48B inFIG. 46 FIGS. 49A, 49B, and 49C are diagrams explaining how the staplerapplies a staple to stitch body tissues together;

FIG. 50 is a perspective view of the stapler according to the thirdembodiment of the invention;

FIG. 51 is a perspective view showing a modification of the stapleraccording to the third embodiment of the invention;

FIG. 52 is an exploded view showing a modified staple pusher;

FIGS. 53A to 53D are diagrams explaining how the modified staple pusherof FIG. 52 deforms a staple to stitch body tissues together;

FIG. 54A is a perspective view of a modified staple, and FIG. 54B is afront view thereof;

FIGS. 55A to 55D are diagrams explaining how the modified staple shownin FIGS. 54A, 54B is deformed to stitch body tissues together;

FIG. 56 is an exploded view showing another modified staple pusher;

FIGS. 57A, 57B, and 57C are diagrams explaining how the modified stapleof FIG. 56 deforms a staple to stitch body tissues together;

FIG. 58 is a perspective view of a modified stapler;

FIGS. 59A and 59B are diagrams explaining how the stapler of FIG. 58applies a staple to fasten body tissues together;

FIGS. 60A, 60B, and 60C are diagrams showing a modified staple pusherand explaining how the staple pusher deforms a staple in various forms;

FIG. 61 is a perspective view of a modified staple;

FIGS. 62A, 62B, and 62C are diagrams showing a modified staple pusherand explaining how the modified staple pusher deforms the modifiedstaple shown in FIG. 61;

FIG. 63 is a sectional side view of a modification of the stapleraccording to the third embodiment of the invention;

FIGS. 64A to 64D are diagrams explaining how the operation section ofthe modified stapler is operated;

FIG. 65 is a perspective view of a stapler according to a fourthembodiment of the invention;

FIGS. 66A, 66B, and 66C are a plan view, right-side view, and left-sideview showing the stapling member of the stapler shown in FIG. 65;

FIG. 67 is a front view of the stapling member;

FIG. 68 is a plan view showing the anvil of the stapling member;

FIG. 69 is a plan view showing the cartridge of the stapling member;

FIG. 70 is a cutaway side view of the stapling member;

FIG. 71 is another cutaway side view of the stapling member, explaininghow a tying thread is applied to body tissues;

FIG. 72 is a plan view showing the channel port incorporated in theoperation section of the stapler;

FIG. 73 is a perspective view illustrating an tissue stitched by thestapler;

FIG. 74 is a side view a modification of the fourth embodiment, which isdesigned to apply staples with a tying thread wound around them;

FIG. 75 is a diagram showing the staples inserted in the cartridge ofthe modified stapler;

FIG. 76 is a plan view of the cartridge, showing the slits containingthe staples;

FIGS. 77A and 77B are perspective view of a severed tissue, FIG. 77Ashowing the tissue to be tied at its severed edge, and FIG. 77B showingthe tissue tied at its severed edge;

FIG. 78 is a perspective view, explaining how an anvil is inserted intothe tissue through the severed edge thereof;

FIG. 79 is a side view illustrating a stapler according to a fifthembodiment of the present invention;

FIG. 80 is a cutaway side view showing the distal end portion of thestapler;

FIG. 81 is a diagram explaining how the stapler applies staples;

FIG. 82 is a side view of a clip applicator which is a sixth embodimentof this invention;

FIG. 83 is a perspective view showing the distal end portion of the clipapplicator;

FIGS. 84 and 85 are diagrams showing a modification of the clipapplicator shown in FIG. 82, respectively;

FIGS. 86 and 87 are diagrams showing another modification of the clipapplicator;

FIG. 88 is a plan view showing the cartridge of a modified staplingmember;

FIG. 89 is a side view showing the modified stapling member and thedistal end portion of the insertion section, to which the staplingmember is connected;

FIG. 90 is a perspective showing the cartridge of the modified staplingmember of a stapler according to a seventh embodiment of the presentinvention;

FIG. 91 is a side view showing the pushers, the cutter, and the membersconnecting the pushers and the cutter--all incorporated in the cartridgeshown in FIG. 90;

FIG. 92 is a front view illustrating the components shown in FIG. 91;

FIG. 93 is a cross-sectional view of the cartridge, taken along the line93--93 in FIG. 90;

FIG. 94 is a cross-sectional view of the cartridge, taken along the line94--94 in FIG. 90;

FIG. 95 is a diagram explaining how to operate the stapler according tothe seventh embodiment of the present invention;

FIGS. 96 and 97 are a side view and top plane view, respectively,showing a mechanism which may be incorporated in the seventh embodiment,for driving the pushers and the cutter;

FIG. 98 is a perspective view of a modification of the cartridge used inthe seventh embodiment;

FIG. 99 is side view showing one of the pushers incorporated in thecartridge shown in FIG. 98 and a wire connected to the pusher;

FIG. 100 is a perspective view of a stapler according to an eighthembodiment of the present invention;

FIGS. 101A and 101B are side views showing the stapling member of thestapler in the open position and the closed position, respectively;

FIG. 102 is a diagram showing the positional relation between thestapling member and the tissues stapled by the member;

FIG. 103 is a sectional side view of the cartridge of the staplingmember;

FIG. 104 is a perspective view showing a stapler according to a ninthembodiment of this invention;

FIG. 105 is a perspective view showing a pusher plate and a thin coiledwire having a first coupling, both incorporated in the stapler of FIG.104;

FIG. 106 is a perspective view of a thick coiled wire having a secondcoupling, which is used in the stapler of FIG. 104;

FIG. 107 is a diagram showing the first and second coupling;

FIG. 108 is a sectional view illustrating the mechanism coupling thecartridge and insertion section of the stapler;

FIG. 109 is a cross-sectional view, taken along line 109--109 in FIG.108;

FIG. 110 is a perspective view showing a stapler according to a tenthembodiment of this invention, except the middle portion of the insertionsection of the stapler;

FIG. 111 is a cutaway perspective view of the flexible portion of theinsertion section of the stapler shown in FIG. 110;

FIG. 112 is a perspective view illustrating a surgical operation systemaccording to the present invention;

FIG. 113 is a cutaway perspective view showing the stapler incorporatedin the surgical operation system; and

FIG. 114 is a block diagram showing the components of the surgicaloperation system.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

A stapler according to a first embodiment of the present invention willbe described with reference to FIGS. 1 to 12.

As shown in FIG. 1, the stapler comprises an operation section 1, aninsertion section 2, and a stapling member 5. The insertion section 2 isconnected at its proximal end to the operation section 1. The insertionsection 2 can freely rotate around its axis in the direction of arrow α.The stapling member 5 comprises a cartridge 3 and an anvil 4 and iscoupled to the distal end of the insertion section 2. The operationsection 1 has an operating member 6 and a staple-driving handle 7. Theoperating member 6 can be pushed and pulled to open and close thestapling member 5. When squeezed in the direction of arrow β, the handle7 drives staples into living tissues to stitch the tissues together.

As shown in FIGS. 2 to 8, the insertion section 2 comprises an innertube 8 and an outer tube 9 mounted on the outer peripheral surface ofthe inner tube 8. The outer tube 9 can move back and forth, sliding onthe inner tube 8, along the axis of the insertion section 2. The distalend portion of the outer tube 9 extends forward farther than the distalend of the inner tube 8. As FIGS. 5 and 6 show, a pair of connectors 10,each formed of a V-shaped spring, are pivotally connected at theirproximal ends to the sides of the distal end portion of the inner tube8. The proximal halves of the connectors 10 extend parallel to eachother. A hinge pin 11 extends at right angles to the axis of the innertube 8, and bridged between the proximal halves of the connectors 10.The end portions of the pin 11 rest in the substantially T-shaped slits12 which is cut in the sides of the outer tube 9 as best shown in FIG.3. The slits 12 serve as guides allowing for the vertical movement ofthe connectors 10 and for the movement of the outer tube 9 against theinner tube 8.

As shown in FIG. 5, an engagement recess 13 is cut in the inner surfaceof the distal end portion of the inner tube 8. A strip-like projection14 protrudes from that region of the distal-end face of the inner tube 8which is located near the engagement recess 13. A leaf spring 15 ismounted on the upper surface of the projection 14.

As shown in FIG. 2, the cartridge 3 has an L-shaped hinge groove 16 inits proximal end, opening at the end face. The hinge pin 11 is insertedin the hinge groove 16. Thus, the pin 11 can move up and down and can beremoved from the cartridge 3.

As can be understood from FIGS. 5 and 6, the anvil 4 has a projection 17protruding from the upper surface of its proximal end portion. Theprojection 17 fits into the recess 13 cut in the inner surface of thedistal end portion of the inner tube 8, when the proximal end portion ofthe anvil 4 is inserted into the distal end portion of the inner tube 8.Then, the proximal end portion of the anvil 4 contacts the leaf spring15 mounted on the upper surface of the projection 14. The spring 15therefore biases the proximal end portion of the anvil 4 upwards. Theprojection 17 of the anvil 4 is thereby remains in the recess 13 of theinner tube 8, whereby the anvil 4 is coupled to the inner tube 8.

As a result, the cartridge 3 can rotate around the hinge pin 11, and theanvil 4 can also rotate, with the projection 17 serving as fulcrum.Hence, the stapling member 5, comprised of the cartridge 3 and the anvil4, can open and close. Normally, the stapling member 5 is in its openposition because the cartridge 3 and the anvil 4 are biased away fromeach other, due to the spring force of the connectors 10 and that of theleaf spring 15 when the outer tube 9 is thrust forward, slipping on theouter surface of the inner tube 8, the inner surface of the distal endof the outer tube 9 abuts on the proximal end portion of the cartridge 3and that of the anvil 4, pressing them toward each other. The staplingmember 5 is thereby closed.

As most clearly shown in FIG. 2 to 4, the stapling member 5 curves byabout 90°. The cartridge 3 and the anvil 4, which are curving so, havecutter-guiding grooves 18 and 19 formed in their inner flat surfaces,opposing each other. The grooves 18 and 19 extend along the axes of thecartridge 3 and the anvil 4 and, hence, are curving. A wire-cutter 20,which will be described later, can slide along the grooves 18 and 19.

The inner surface of the cartridge 3 has slits 21 arranged in fourrows--two rows extending on one side of the cutter-guiding groove 18,and two rows on the other side of the groove 18. As shown in FIG. 8,pushers 21a are slidably placed in the slits 21, respectively, andU-shaped staples 22 are inserted in the slits 21 and mounted on thepushers 21a, respectively.

The staples 22 are made of electrically conductive material such asstainless steel, titanium or tantalum, or electrically insulatingmaterial such as polylactide, polyglycolide or polydioxanone. Whichmaterial is selected for the staples 22 is determined by the intendeduse of the staples 22.

A pair of plate-guiding grooves 23 extend within the cartridge 3, alongthe curving axis thereof. A pair of pusher plates 24 can be moved backand forth along the plate-guiding grooves 23 as will be described later.

The anvil 4 has shallow grooves 25 formed in its inner surface as isillustrated in FIG. 8. These grooves 25 are arranged in four rows,--tworows extending on one side of the cutter-guiding groove 19, and two rowson the other side of the groove 19. The grooves 25 will meet thecorresponding slits 21 of the cartridge 3 when the cartridge 3 and theanvil 4 are closed together. Each of the grooves 25 has an arcuatebottom so that both legs 22a and 22b of the staple 22 may be bentinwards, or toward each other as the staple 22 is pushed against thebottom of the groove 25.

The wire-cutter 20 and the pusher plates 24 are located within the innertube 8 of the insertion section 2. The inner tube 8 has a groove 26 cutin its inner surface. This groove 26 is continuous to the cutter-guidinggroove 18 of the cartridge 3 and the cutter-guiding groove 19 of theanvil 4. Slidably inserted in the groove 26 is a cutter holder 28. Thecutter holder 28 has two wire-holding projections protruding from itsdistal-end face and spaced apart from each other. The wire-cutter 20,which is a wire, is stretched vertically between the wire-holdingprojections of the holder 28. The wire-cutter 20 and the cutter holder28 constitute a knife unit 29.

As shown in FIG. 6, the inner surface of the inner tube 8 includes apair of plate-guiding surfaces 30 which are flush with the bottom of theplate-guiding grooves 23 formed in the cartridge 3. The pusher plates 24made of metal plates are slidably mounted on the plate-guiding surfaces30, respectively. The distal end 24a of each pusher plate 24 inclinesdownwards as is illustrated in FIG. 4.

The wire-cutter 20 and the pusher plates 24 are fastened at theirproximal ends to the upper end of the staple-driving handle 7 (FIG. 1).Alternatively, their proximal ends may be connected by connecting meanssuch as wires to the upper end of the handle 7, not directly fastenedthereto. When the handle 7 is squeezed in the direction of arrow β shownin FIG. 1, the wire-cutter 20 and the pusher plates 24 are thrustforward through the inner tube 7, moving into the cartridge 3 and theanvil 4.

The outer tube 9 is coupled at its proximal end to the operating member6. As mentioned above, the operating member 6 is mounted at the rear ofthe operation section 1 and can be pushed and pulled. Thus, when themember 6 is pushed forward to the position indicated by the solid linesin FIG. 1, the outer tube 9 is moved forward, sliding on the inner tube8. Subsequently, the inner surface of the outer tube 9 abuts on theproximal ends of the cartridge 3 and the anvil 4, thereby closing thestapling member 5. Conversely, when the member 6 is pulled backward tothe position indicated by the broken lines in FIG. 1, the outer tube 9is moves backward, and its inner surface bias the proximal ends of thecartridge 3 and the anvil 4. As a result, the cartridge 3 and the anvil4 are rotated away from each other, by virtue of the spring force of theconnectors 10 and that of the leaf spring 15; the stapling member 5 isopened.

As illustrated in FIG. 12, an electric conductor member 31 extendsthrough the operation section 1 and is connected at the distal end tothe wire-cutter 20. The proximal end of the conductor 31 is connected toa connecting pin 32 protruding from the operation section 1. As may beunderstood from FIG. 1, a switch S is mounted on the rear end portion ofthe electric conductor 31, for supplying and not supplying ahigh-frequency current to the wire-cutter 20. The switch S is exposed onone side of the operation section 1 and can, therefore, be operated fromoutside.

As FIG. 11 shows, a cable 33 has a connector 34 at one end. Theconnector 34 is coupled to the connecting pin 32. The other end of thecable 33 is connected to a high-frequency cautery device 35. The cauterydevice 35 can be controlled over a broad range to generate ahigh-frequency current which has a desired waveform and desiredcharacteristics. Thus, the device 35 can supply a large incisioncurrent, a high coagulation current, or a mixed current serving as bothan incision current and a coagulation current, in accordance with theuse of the stapler shown in FIG. 1. Usually, a predetermined power ofabout 50 W is applied to the wire-cutter 20 to form an incision in abody wall. Nonetheless, the cautery device 35 can be controlled to setthe output power at a suitable value in accordance with the locationand/or condition of the living tissues which are to be stapled andsevered.

The stapler described above is operated in the following way. A bodywall or the like is incised. The stapling member 5 and the insertionsection 2 are inserted into a body cavity through the incision. Sincethe stapling member 5 curves by about 90° with respect to the axis ofthe insertion section 2, it can be easily inserted into the body byrotating the section 2 in the direction opposite in that direction inwhich the member 5 is curving.

The insertion section 2 is inserted deeper into the body cavity, thusmoving the stapling member 5 toward body tissues A to be stapledtogether. At this time, the operating member 6 is pulled to the positionindicated by the broken lines in FIG. 1. The outer tube 9 is therebypulled back, exposing the cartridge 3 and the anvil 4. Released from theouter tube 9, the cartridge 3 is rotated outwards by the spring force ofthe connectors 10, and the anvil 4 is rotated outwards by the force ofthe leaf spring 15. In other words, the stapling member 5 is opened. Themember 5, now open, is moved such that the tissues A are caught betweenthe cartridge 3 and the anvil 4. Then, the operating member 6 is pushedto the position represented by the solid lines in FIG. 1. The outer tube9 is thereby moved forward, abutting at its inner surface on the distalend portion of the cartridge 3 and that of the anvil 4. The staplingmember 5 is closed, thus clamping the body tissues A.

In this condition, the staple-driving handle 7 is squeezed in thedirection of arrow β, moving the pusher plates 24 forward first throughthe inner tube 8 and then along the plate-guiding grooves 23, and alsomoving the wire-cutter 20 forward along the cutter-guiding grooves 18and 19 formed in the opposing surfaces of the cartridge 3 and the anvil4, respectively.

As the pusher plates 24 advance forward, their inclining distal ends 24apush up the pushers 21a of each row sequentially, ultimately driving thestaples 22 into the tissues A, one after another. The legs 22a and 22bof each staple 22 pierce the living tissues A, abut on the bottom of thegroove 25 formed in the inner surface of the anvil 4, and have theirtips bent inwardly. As a result of this, the tissues A are stitchedtogether with the staples 22 arranged in four parallel rows.

At the same time the tissues A are stitched together with four rows ofstaples 22, the wire-cutter 20 advances along the grooves 18 and 19. Thecutter 20 cuts the tissues A along a curving line extending between theinner two rows of staples 22. This is because, as is best shown in FIG.2, the grooves 18 and 19 extend between the inner two rows of slits 21formed in the inner surface of the cartridge 3. Thus, the body tissues Aare stapled and severed almost at the same time.

As the tissues A are stapled and severed, a high-frequency current issupplied from the cautery device 35 to the wire-cutter 20 of the knifeunit 29 via the cable 33 and the electric conductor 31. Therefore, thetissues A is cauterized while being stitched together. Since the tissuesA are severed while being cauterized, there is no risk of bleeding atthe severed portions of the living tissues A.

Supplied with the cautery current (i.e., the high-frequency current),the wire-cutter 20 is heated. The cutter 20 need not have a sharp edgefor severing body tissues.

As has been indicated, the stapling member 5 curves by about 90° withrespect to the axis of the insertion section 2. It can therefore easilycatch the target tissues A, particularly in the case where the tissues Aare located on the axis of the section 2. Further, the stapling member 5can be directed to any desired direction since the insertion section 2can freely rotate with respect to the operation section 1.

FIGS. 13, 14, and 15 show modified pusher plates 24. Each of themodified pusher plate 24 has a slit 44 which extends along its lengthand opening at its forward end. Hence, the slit 44 defines a lower strip44a and an upper strip 44b. The lower strip 44a is in sliding contactwith the bottom of the plate-guiding groove 23 formed in the cartridge3. The upper edge of the upper strip 44bsupports the pushers 21a. Anumber of compression coil springs 45 are interposed between the strips44a and 44b, supporting the upper strip 44bsuch that the strip 44 canmove up and down.

As the modified pusher plates 24 are moved forward along theplate-guiding grooves 23, they push the pushers 21a of each row, oneafter another. The pushers 21a push the staples 22 upward through theslits 21. The staples 22 are thereby driven into the target tissues A.The legs 22a and 22b of each staple 22 pierce the living tissues A, abuton the bottom of the groove 25 formed in the inner surface of the anvil4, and have their tips bent inwardly. The tissues A are thereby stitchedtogether with the staples 22 arranged in four parallel rows.

Any staple leg driven into a soft part x of the tissues A has a longbent tip, whereas any staple leg driven into a hard part y of thetissues A has a short bent tip--as is illustrated in FIG. 15. This isbecause the compression coil springs 45 are compressed more greatly whena staple 22 is driven into a hard part y, allowing the upper strip 44bto move downwards for a longer distance, than when a staple 22 is driveninto a soft part x. Hence, any parts of the tissues A can be stitchedtogether with the same clamping force, regardless of their hardness.This achieves neat and reliable stapling of living tissues.

FIG. 16 shows a modified pusher plates 24. This pusher plate 24 has aslit 46 cut in the distal end. The slit 46 inclines downward and towardthe distal end and opening at the upper edge of the plate 24. Because ofthe slit 46, the distal end portion of the pusher plate 24 canplastically deformed when it abut on each pusher 21a. Hence, themodified pusher plate 24 has the same advantage as the modified pusherplates 24 shown in FIG. 14.

A modification of the stapling member 4 will be described with referenceto FIGS. 17A, 17B and 17C, FIGS. 18A and 18B, FIG. 19, and FIGS. 20A and20B.

The modified stapling member 5 has a cartridge 3 and an anvil 4. As isshown in FIGS. 17A to 17C and FIGS. 18A and 18B, the cartridge 3 isstraight and has a cutter-guiding groove 18 and two rows of slits21--all made in its upper surface. The groove 18 extends straight alongthe axis of the cartridge 3. The rows of slits 21 extend straight,parallel to the cutter-guiding groove 18, one row on one side of thegroove 18 and the other row on the other side thereof. The slits 21 ofeach row are inclined to the groove 18 along which a wire-cutter (notshow) is moved back and forth. Each slit 21 of one row laps at leastpartly with the corresponding slit 21 of the other row.

As shown in FIG. 18B, the anvil 4 is straight and has a cutter-guidinggroove 19 and two rows of grooves 25--all made in its upper surface. Thegroove 19 extends straight along the axis of the anvil 4. The rows ofgrooves 25 extend straight, parallel to the cutter-guiding groove 19,one row on one side of the groove 19 and the other row on the other sidethereof. The grooves 25 of each row are inclined to the groove 1 alongwhich a wire-cutter (not show) is moved back and forth. The grooves 25are so located as to meet the corresponding slits 21 of the cartridge 3when the cartridge 3 and the anvil 4 are closed together. Each of thegrooves 25 has an arcuate bottom so that both legs 22a and 22b of astaple 22 may be bent inwards, or toward each other as the staple 22 ispushed against the bottom of the groove 25.

As shown in FIG. 20B, the inner surface of the cartridge 3, whichopposes that of the anvil 4, is curved in the form of letter U, and theinner surface of the anvil 4 is rounded complementary to the U-curvedinner surface of the cartridge 3. Further, the cartridge 3 and the anvil4 have rounded outer surfaces of substantially the same curvature.Hence, the stapling member 5 has a circular cross section, while closedwith the cartridge 3 and the anvil 4 placed in their closed positions.This helps to insert the stapling member 5 smoothly into a body cavity.

Another modification of the stapling member 5 will be described withreference to FIGS. 21, 22, and 23. This stapling member 5 ischaracterized in that the anvil 4 has in its inner surface two rows ofgrooves 25a on either side of the cutter-guiding groove 19, not one rowof grooves 25a on either side of the groove 19 as in the staplingmembers 5 described above. Further, any corresponding two groove 25a ofthe rows are so directed and shaped that they serve to bent the legs 22aand 22b of a staple 22 toward each other but in staggered fashion as isillustrated in FIGS. 22 and 23.

More specifically, when each staple 21 is ejected from the cartridge 3,its legs 22a and 22b pierce body tissues and subsequently abut on thebottoms of the grooves 2. As a result, the tips of the legs 22a and 22bare bent toward each other, but in staggered fashion. With the leg tipsthus bent, the staple 22 fastens the tissues so steadfastly that no bodyfluid such as blood or lymph will ooze out through the gaps between thestaples 22.

FIGS. 24A and 24B show a modification of the staple 22. As shown in FIG.24A, the modified staple 22 is characterized in that the head portion22c connecting the legs 22a and 22b is arcuated in the planeperpendicular to the legs 22a and 22b, not straight as those of thestaples described above. The tips of the legs 22a and 22b will be bentto curve in the same way as the head portion 22c when the staple 22 isapplied by the stapler.

Stables 22 of this type are applied to body tissues, forming two rows asshown in FIG. 24B, such that the staples 22 of the first row arestaggered by half pitch with respect to those of the second row, andthat the head portion 22c of each staple 22 of one row surrounds theends the head portions 22c of two adjacent staples 22 of the other row.Applied in this manner, the staples 22 stitch the body tissues firmlyand reliably.

FIGS. 25A and 25B show another modification of the staple 22. As shownin FIG. 25A, this staple 22 consists of a straight head portion 22c andtwo straight legs 22a and 22b extending downward from the ends of thehead portions 22c. The staple is characterized in that when it isapplied, the tips of its legs 22a and 22b will be bent in the oppositedirections as shown in FIG. 25A.

Stables 22 of the type shown in FIG. 25A are applied in the followingway. The staples 22 are arranged in at least two rows on the sides ofthe cutter-guiding groove 18 of the cartridge 3, such that the headportions 22a of the staples 22 of each row extend at right angles to thegroove 18 as is illustrated in FIG. 25B. Also, the staples 22 arearranged at such intervals that, when the legs 22a and 22b of eachstaple 22 are bent at their tips, the tips will lap the leg tips of theadjacent staples 22 as shown in FIG. 25B. The staples 22, thus arranged,are driven into body tissues, and the tips of their legs 22a and 22b aresubsequently bent. Applied in this manner, the staples 22 stitch thebody tissues firmly and reliably.

FIGS. 26A and 26B show still another modification of the staple 22. Asshown in FIG. 26A, the staple 22 consists of a straight head portion 22cand two straight legs 22a and 22b extending downward from the ends ofthe head portions 22c. The staple is characterized in that when it isapplied, the tips of its legs 22a and 22b will be bent at right anglesto the remaining portions of the legs 22a and 22b and will be inclinedto the head portion 22c at predetermined angles other than 90° in theopposite directions as shown in FIG. 25B.

Stables 22 of the type shown in FIG. 26A are applied in the followingway. The staples 22 are arranged in at least two rows on the sides ofthe cutter-guiding groove 18 of the cartridge 3, such that the headportions 22a of the staples 22 of each row incline to the groove 18 asis illustrated in FIG. 26B. Also, the staples 22 are arranged at suchintervals that, when the legs 22a and 22b of each staple 22 are bent attheir tips, one of the tips will lap the head portion 22c of the nextstaple 22 as shown in FIG. 26B. The staples 22, thus arranged, aredriven into body tissues, and the tips of their legs 22a and 22b aresubsequently bent as shown in FIG. 26A. Applied in this manner, thestaples 22 stitch the body tissues firmly and reliably.

FIGS. 27A and 28A are plan view of two types of grooves 25b and 25c,which are modifications of the grooves 25a described above.

The groove 24b shown in FIG. 27A consists of a pair of segment grooveswhich incline to each other. As the legs 22a and 22b of a substantiallyU-shaped staple 22 are pushed against the bottoms of these segmentgrooves, the tips of the legs 22a and 22b are bent, assuming the shapesidentical to those of the segment grooves, as is illustrated in FIG.27B.

The groove 25cshown in FIG. 28A is arching. As the legs 22a and 22b of asubstantially U-shaped staple 22 are pushed against the bottom of theend portions of the groove 25c, the tips of the legs 22a and 22b arebent, each arching toward the other, as is illustrated in FIG. 28B.

A stapler according to a second embodiment of the present invention willbe described with reference to FIGS. 29 to 34 and FIGS. 35A, 35B and35C.

As shown in FIG. 29, the stapler comprises an operation section 1, aninsertion section 2, and a stapling section 2a connected to the distalend of the insertion section 2. The operation section 1 has astaple-driving handle 7 and a staple-bending lever 7a. The insertionsection 2 is connected at its proximal end to the operation section 1,freely rotate around its axis. The stapling section 2a is coupled to thedistal end of the insertion section 2.

The stapling section 2a contains a staple-ejecting member 70 and has astylus 71 protruding from its distal-end face.

As sown in FIGS. 30, 31, and 32, the stapling section 2a of theinsertion section 2, has a staple-holding groove 72 and an anvil-holdinggroove 73, both provided within the portion 2a and extending along theaxis thereof. A staple track 74 rests in the staple-holding groove 72.The staple track 74 is a metal strip and has, at its distal end, aninclining portion 74a and a cam 75. As is best shown in FIG. 33, the cam75 is connected to the portion 74a and has a channel-shaped crosssection.

A staple-holding plate 76 is located above the staple track 74, spacedapart therefrom for a predetermined distance and extending substantiallyparallel to the staple track 74. Staples 22 are held between the gap ofthe staple track 74 and the staple-holding plate 76, arranged, end toend, in the lengthwise direction of section 2a. Each staple 22 is madeof a thin wire bent in the form of A. The staples 22 are positioned withtheir legs directed to the distal end of the stapling section 2a and arebiased toward the staple outlet 78a by a coil spring 77 which pushes therearmost staple 22.

A staple pusher 79 is mounted on the staple-holding plate 76 and canslide back and forth through a passage 80. A horizontal groove (notshown) is formed in the distal-end face of the staple pusher 79, whichserves as a staple-pushing member 79a. The staple pusher 79 has aprojection 79b protruding from the upper surface. The projection 79b isconnected to the staple-driving handle 7 incorporated in the operationsection 1. Hence, as the handle 7 is rotated, the staple 79 slidesthrough the stapling section 2a, back and forth between the stapleoutlet 78a and the staple-pushing member 79a.

An anvil 81 is located in the anvil-holding groove 73 and can move backand forth. The anvil 81 has a slit 81a in the middle portion and aprojection 81b protruding from the upper surface. The projection 81b isinserted in a groove 73a formed in the bottom of the anvil-holdinggroove 73. Hence, the anvil 81 can be moved but for a distance equal tothe length of this groove the 73a. The projection 79b of the staplepusher is loosely inserted in the slit 81a.

A flange 81c extends downwards from the distal end of the anvil 81. Theflange 81c abuts on the middle portion a staple 22, making it easy tobend the staple 22. The anvil 81 has a slit 81d located between theprojection 81b and the flange 81c. A release spring 82 is inserted inthe slit 81d. The front end of the spring 82 contacts the front of theslit 81d, and the rear end of the spring 82 is held in a hole made inthe upper surface of the anvil 81. The middle portion of the spring 82is bent, forming a V-shaped portion 82a which extends downwards throughthe slit 81d. The V-shaped portion 82a can accumulates a force strongought to release each staple 22 from the flange 81c.

The staple-ejecting member 70 contained in the stapling section 2a has astaple-ejecting opening 70a and a staple-ejecting groove 70bcommunicating with the opening 70a, both formed in the distal-end faceof the section 2a. The staple-ejecting groove 70b has a width forallowing the passage of the staples which have been deformed.

The stapling section 2a is rotatably coupled to the distal end 2c of theinsertion section 2. To be more specific, the stapling section 2a iscovered by a hollow cylindrical cover 85, the distal end 2c of thesection 2 is covered by a hollow cylindrical cover 86. The cover 85 ishinged to the cover 86 by a hinge 87.

An operating wire 7a extends through the hollow cylindrical cover 86 andthe hinge 87 and is connected at its rear end to the staple-bendinglever 7a of the operation section 1. The distal end of the wire 7a isfastened to the hollow cylindrical cover 85. The hinge 87 contains acoil spring 88. The spring 88 connects the covers 85 and 86, end to end,biasing the insertion section 2 and the stapling section 2a in mutualaxial alignment.

The proximal end portion 2b of the stapling section 2a has an axialthrough hole 89. The proximal end portion of the staple pusher 79 isslidably inserted in this hole 89 and has a large rear end. Acompression spring 97 is located in the hole 89, loosely mounted on theproximal end portion of the staple pusher 79 and interposed between thelarge end of the pusher 79 and the front edge of the hole 89. The spring97 therefore biases the staple pusher 79 toward the operation section 1.

The insertion section 2 has an axial through hole 98. An operation wire90 extends through this hole 98 and is connected at the rear end to thestaple-driving handle 7, and at the front end to the proximal end of thestaple pusher 79. As shown in FIG. 34, the wire 90 is wrapped with acoil sheath 92, which in turn is covered by an operating tube 92 made ofsoft material. The distal end portions of the sheath 91 and the tube 92extend through the hinge 87 and coupled to the proximal end portion 2bof the stapling section 2a.

When the staple-bending lever 7a is rotated toward the proximal end ofthe operation section 1, the operating wire 7a is pulled in the samedirection, rotating the hollow cylindrical cover 85, with the hinge 87serving as fulcrum. Thus, the stapling section 2a is rotated withrespect to the insertion section 2. When the lever 7a is released, thecoil spring 88 contained in the hinge 87 rotates the cover 85 in theopposite direction, placing the same into the axial alignment with thehollow cylindrical cover 86. The stapling section 2a thereby resumes theaxial alignment with the insertion section 2, whereby the sections 2 and2a forms a straight unit.

A lock mechanism may be used to lock the staple-bending lever 7a in thepulled condition so that the stapling section 2a remains rotated orinclined with respect to the insertion section 2. Even while the section2a is so rotated, the operation wire 90 can move the staple pusher 79when the staple-driving handle 7 is squeezed, and the pusher 79 candeform the staple 22.

Referring back to FIG. 29, the operation section 1 contains an electricconductor 31 and has a connecting pin 32 protruding outwards. The pin 32can be connected to the connector 34 fastened to an end of a cable 33which is connected at the other end to a high-frequency cautery device35. The conductor 31 extends from the pin 32 through the insertionsection 2 and the stapling section 2a. As shown in FIG. 30, theconductor 31 is connected to the stylus 71 which protrudes from thedistal-end face of the stapling section 2a. That portion of the stylus71 which is embedded in the distal end of the section 2a is wrapped withan insulator 71b such as a rubber tube and is therefore electricallyinsulated from the stapling section 2a.

The stapler shown in FIG. 29 is manipulated to apply staples 22 in thefollowing manner, to stitch body tissues together.

When the staple-driving handle 7 is squeezed in the direction of arrow βshown in FIG. 1, pushing the operating wire 90 forward. The staplepusher 79 connected to the staple pusher 79 is moved forward. Thestaple-pushing member 79a of the pusher 79 abuts on the arching endportions of the staple 22, pushing the staple 22 forward. The staple 22pushes the rear half of the V-shaped portion 82a of the release spring82. The spring 82 is thereby thrust forward. The anvil 81, which holdsthe spring 82 in its slit 81d, is subsequently moved forward, too.

The anvil 81 stops moving the moment the projection 8lb abuts on thefront edge of the groove 73a formed in the bottom of the anvil-holdinggroove 73. By contrast, the staple pusher 79 and the staple 22 arefurther moved forward. When released from the middle portion of thestaple 22, the release spring 82 pushed upwards, making the staple 22move to a position in front of the spring 82. At this time, the middleportion of the staple 22 abuts on the flange 81c which extends downwardsfrom the distal end of the anvil 81.

As the staple pusher 79 is further moved forward, the staple 22 isclamped between the staple-pushing member 79aand the flange 81c and iseventually deformed or closed. More specifically, the projections of themember 79apush the arching end portions of the staple 22, while theflange 81c holds the middle portion of the staple 22. Hence, the endportions of the staple 22 are bent forward until they abut on eachother. Meanwhile, the V-shaped portion of the spring 82 is keptcompressed by the staple-pushing member 79a, spring 82 accumulatesforce. At this time, the handle 7 can no longer be squeezed further.When the handle 7 is released, the operating wire 90 is pulled towardthe operation section 1, moving the staple pusher 79 backward. Then, therelease spring 82 exerts the accumulated force on the closed staple 22,whereby the staple 22 is released from the flange 81c and subsequentlyejected from the stapling section 2a, passing through thestaple-ejecting groove 70b which is formed in the distal-end face of thesection 2a.

As the staple pusher 79 is moved toward the operating section 1 afterthe staple 22 has been deformed, the projection 79b of the staple pusher79 abuts on the read end of the slit 81a of the anvil 81. The anvil 81is, therefore, moved toward the operation section 1, too. Both thestaple pusher 79 and the anvil 81 are moved until the projection 81b ofthe anvil 81 abuts on the rear edge of the groove 73a. When the staplepusher 79 and the anvil 81 are stopped, the staple outlet 78a is nolonger covered by the pusher 79. Now that the staple outlet 78a isopened, the next staple 22 is pushed toward the distal end of the staplepusher 79, by virtue of the spring force of the staple track 74.

The distal end of the staple track 74 closes the staple-holding groove72 and the staple outlet 78a. Thus, the next staple 22 is prevented frommoving outward through the outlet 78a. At the time the staple pusher 79passes over the outlet 78a, the lower surface of the pusher 79 contactsthe cam 75 which is integral with the staple track 74. Thereafter, thedistal end portion of the staple track 74 is pushed back into thestaple-holding groove 72, and the next staple 22 is moved to the distalend of the staple track 74.

With reference to FIGS. 35A, 35B, and 35C, it will be described how thestapler shown in FIG. 29 is manipulated to stitch a wound c. First, asshown in FIG. 35A, the distal end of the stapling section 2a is placedon the tissues a and b on the sides of the wound c. As a result, thestylus 71 is driven into one of the tissues, for example tissue A. Then,as shown in FIG. 35B, the stapling section 2a is moved sideways, pullingthe tissue a to the tissue b, thus closing the wound c. In thiscondition, the staple pusher 79 is moved for ward. The staple 22 is bentuntil their end portions pierce into the tissues A and b and finallyabuts on each other at the closed wound c as illustrated in FIG. 35C.The wound c is thereby stitched.

Before driven into the tissue A, the stylus 71 is placed in touch withthe tissue A. Then, a high-frequency current is supplied from thecautery device 35 to the stylus 71 via the cable 33, the connecting pin32, and the conductor 31. The energized with this current, the stylus 71generates heat. The heat is applied to a limited portion of the tissueA, thereby cauterizing this portion. Once cauterized, the tissue abecomes easy to pierce, allowing a smooth penetration of the stylus 71.Even if the stylus 71 pierces a blood vessel, if any in the cauterizedportion, there will be no bleeding because the blood vessel has beencauterized.

The use of the stylus 71 enables a surgeon to stitch and close the woundc easily, with a single hand, while recognizing where the tissues a andb are located.

A modification of the stapler shown in FIG. 29, i.e., the secondembodiment of the invention, will be described with reference to FIGS.36A and 36B and FIGS. 37 and 38.

As shown in FIG. 37, a hollow cylindrical cover 100 covers almost theentire length of an insertion section 2. The cover 100 can be slid alongthe axis of the insertion section 2. When moved to a forward position,the cover 100 covers a stylus 71 protruding from the distal end of thesection 2. The cover 100 is connected at its proximal end to the body laof an operation section 1 an can rotated around its axis.

The operation section 1 has a staple-driving handle 7 which is rotatablycoupled to the body 1a. As FIG. 38 shows, a pin 103 protrudes from thehandle 7 and fitted in an elongated hinge hole 105 formed in one arm ofan L-shaped pusher link 104. A sliding cam 106 is rotatably connected tothe staple-driving handle 7. An L-shaped sliding member 107 is movablyconnected to the sliding cam 106 by a U-shaped pin 108. Am operatingwire 90 is connected at the rear end to the other arm of the pusher link104, and the forward end to a stapler pusher 79. The sliding member 107is coupled to the hollow cylindrical cover 100. A spring 109 isconnected to the pusher link 104, biasing the staple-driving handle 7 torotate in the direction opposite to the direction of arrow β.

When the staple-driving handle 7 is squeezed in the direction of arrowβ, the sliding cam 106 is moved up, pushing the sliding member 107backward. The cover 100, which is connected to the sliding member 107,is thereby slid backward, exposing the stylus 71 protruding from thedistal end of the insertion section 2. As the handle 7 is furthersqueezed in the direction of arrow β, the pusher ling 104 is rotated,pushing the staple pusher 79 forward. Thus pushed, the pusher 79 deformsa staple 22, stitching body tissues together.

Since the cover 100 covers the stylus 71 unless the staple-drivinghandle 7 is squeezed, there is no risk that the stylus 71 damages thetissues within a body cavity. A ratchet may be engaged with the handle 7so that the handle 7 may be latched in a position to hold the cover 100at its forward position.

FIGS. 39A, 39B, and 39C show a modified stylus 71. As shown in FIG. 39A,this stylus 71 has a tip 71e which curves toward the axis of theinsertion section 2. Due to the curving tip 71e the stylus 71 helps tomove the tissue a to the tissue b as shown in FIG. 39B. Hence, the woundc can be reliably closed and stitched with staple 22 as is illustratedin FIG. 39C.

FIGS. 40A and 40B show the distal-end portion of a modified insertionsection 2. As shown in these figures, a bore 111 is formed in thedistal-end portion of the section 2. A stylus 71 is contained in thisbore 111 and biased by a spring 113 to move away from the distal-endface of the section 2. The rear end of the stylus 71 is connected to arod 114 which extends through the insertion section 2 and connected tothe operation section 1. Hence, when the rod 114 is thrust forward, thestylus is pushed out of the hole 111 against the force of the spring113. The stylus 71 remains in the bore 111 unless pushed by the rod 114,and would not damage tissues within a body cavity.

FIG. 41 illustrates a modification of the insertion section 2. Themodified section 2 is characterized by two styluses 71 which protrudefrom the distal-end face of the section 2, extending parallel to eachother. Once driven into a tissue at positions on one side of a wound,the styluses 71 serve to close the wound more neatly than is possiblewith a single stylus. If necessary and possible, three or more stylusesmay be fastened to the distal-end face of the section 2 to accomplishneat wound-closing and wound-stitching.

FIGS. 42A, 42B, and 42C show another modification of the insertionsection 2. This modified section 2 is characterized in that a suctiontube 120 is used in place of the stylus 71. The tube 120 is located nearthe staple-ejecting member 70 and is connected to a vacuum pump or thelike (not shown). The insertion section 2 is moved until the suctiontube 120 touches a tissue a. The vacuum pump or the like is driven,whereby the section 2 holds the tissue a. The section 2 is movedsideways, bringing the tissue a into contact with the tissue b and thusclosing the wound c. Then, a staple 22 is driven into the tissues a andb, thereby stitching the wound c. With this modified insertion section 2it is easy to find the wound c (or an incision), improving theoperability of the stapler.

FIGS. 43A, 43B, and 43C show another modification of the insertionsection 2. This modified section 2 is characterized in that ascoop-shaped member 121 protrudes from the distal-end face and islocated near the staple-ejecting member 70. The insertion section 2 ismoved until the member 121 catches a tissue a. The section 2 is thenmoved sideways, whereby the member 121 brings the tissue a into contactwith the tissue b and thus closing the wound c. Then, a staple 22 isdriven into the tissues A and b, thereby stitching the wound c. Sincethe scoop-shaped member 121 is slender, it does not hide the wound c.Nor does it damage the tissues since its tip is rounded. The member 121may assume any other shape, provided that it can easily take hold of atissue.

A stapler according to a third embodiment of the invention will bedescribed, with reference FIG. 44, FIGS. 45A, 45B and 45C, FIG. 46, FIG.47, FIGS. 48A and 48B, FIGS. 49A, 49B and 49C, and FIG. 50.

FIGS. 44 and FIGS. 45A, 45B and 45C show a stapling mechanismincorporated in the distal end portion of an insertion section 2. Thesection 2 comprises an upper cover 2e and a lower cover 2f. The uppercover 2e has a staple-ejecting opening 70a at its end face. The lowercover 2f has a staple-ejecting groove 70b formed in its end face. Thelower cover 2f has a staple-holding groove 72 formed in its innersurface, and the upper cover 2e has an anvil-holding groove 73 formed inits inner surface. A staple track 74 rests in the staple-holding groove72. The staple track 74 is a metal strip and has, at its distal end, aninclining portion 74a and a cam 75.

A staple-holding plate 76 is located above the staple track 74. Theplate 76 has a claw 76d which prevents a forward movement of the plate76. Staples 22 are held between the gap of the staple track 74 and thestaple-holding plate 76, arranged, end to end, in the lengthwisedirection of the insertion section 2. Each staple 22 is made of a thinwire bent in the form of ω. The staples 22 are positioned with theirlegs directed to the distal end of the insertion section 2 and arebiased toward the staple outlet 78a by a coil spring 77 which is held inthe staple-holding groove 72 and which pushes the rearmost staple 22.

Mounted on the staple-holding plate 76 are a right staple pusher 791 anda left staple pusher 79m which extend along the axis of the section 2,parallel to each other. The pushers 791 and 79m can move back and forthinto and out of the staple outlet 78a, and constitute a staple pusher79. The right staple pusher 791 has a cutout at its distal end. Becauseof this cutout, the distal end portions of the pushers 791 and 79mdefine a U-notch 79a. An electrode E is mounted on the distal end of thestaple pusher 79. An electric conductor 31 is connected at the forwardend to the electrode E and at the rear end to a connecting pin 32 whichprotrudes from an operation section 1 as shown in FIG. 50. The electrodeE is connected to the staple pusher 79 in the case where the pusher 79is made of insulating material such as synthetic resin, or connected toan insulating coating or an insulator covering the pusher 79 in the casewhere the pusher 79 is made of electrically conductive material such asmetal. The distal end of the electrode E extends into the U-shaped notch79a and is exposed therein. Hence, the electrode E can contact a staple22 at least while the staple 22 remains in the distal end of theinsertion section 2 immediately before it is deformed.

The right staple pusher 791 has a projection 79b and a hole 78e.Inserted in the hole 78e is the claw 76d of the staple-holding plate 76.Both the right staple pusher 791 and the left staple pusher 79m arebiased backward by a return spring 130 which is contained in the distalend portion of the operation section 1. The pushers 791 and 79m arecoupled to a staple-driving handle 7 by a connecting means (laterdescribed). As the handle 7 is operated, the pushers 791 and 79m canmove back and forth between the staple outlet 78a and a staple-formingsection 78b.

An anvil 81 is located above the right right staple pusher 791 andinserted in the anvil-holding groove 73. The anvil 81 can move back andforth. The anvil 81 has a slit 81a and a projection 81b. In the slit 81athe projection 79b of the right staple pusher 791 is fitted. Theprojection 81b protrudes from the upper surface and inserted in a groove73a formed in the bottom of the anvil-holding groove 73. The groove 73aprevents an excessive movement of the anvil 81.

A flange 81c extends downwards from the distal end of the anvil 81. Theflange 81c abuts on the middle portion a staple 22, making it easy tobend the staple 22. The anvil 81 has a slit 81dlocated between theprojection 81b and the flange 81c. A release spring 82 is inserted inthe slit 81d. The middle portion of the spring 82 is bent, forming aV-shaped portion 82a which extends downwards through the slit 81d. TheV-shaped portion 82a can accumulates a force strong enough to releaseeach staple 22 from the flange 81c.

FIGS. 46 and 47 and FIGS. 48A and 48B show the operation section 1. Asis shown in FIG. 46, the staple-driving handle 7 is rotatably coupled tothe frame 1a of the section 1 by a pivot pin 132 and is biased by aspring 133 to rotate in the direction opposite to arrow β.

A hollow cylindrical pusher 135 is coupled to the upper end of thehandle 7 by a connecting pin 134. The pusher 135 can therefore be movedback and forth as the handle 7 is rotated. The pusher 135 has fourcontinuous cam surfaces 135a formed on the distal-end face and arrangedin the circumferential direction of the pusher 135. A hollow cylindricalswitching member 137 is located in front of the pusher 135 and can moveback and forth. The member 137 has a round cam surface 137a at itsdistal end. This cam surface 137a opposes the cam surfaces 135a of thepusher 135.

The switching member 137 is biased toward the operation section 1 by abias spring 136. The member 137 has elongated guides 139 formed on theouter circumference of the member and spaced at regular intervals in thecircumferential direction. The guides 139 have a cam surface 139a eachat the end and are set in sliding engagement with grooves 138 formed inthe inner surface of the frame 1a, respectively. Each groove 138 extendsalong the axis of the operation section 1 and is defined by a pair ofparallel strips 138b which protrudes from the inner surface of the frame1a. A hollow cylindrical outer pusher 140 protrudes from the distal-endface of the switching member 137. Four inner pushers 141 protrude fromthe distal-end face of the member 137, too, and extend through the outerpusher 140 as is shown in FIG. 48. The inner pushers 141 are parallel toone another and spaced apart by angular distance of 90° .

Both the hollow cylindrical pusher 135 and the switching member 137 areprevented from rotating around their axes by means of the grooves 138formed in the inner surface of the frame 1a. While the pusher 135 issupported in the grooves 138, its cam surfaces 135a abut on the camsurface 137a of the switching member 137, displaced by 1/4 pitch withrespect to the cam surface 1237a.

When the staple-driving handle 7 is squeezed in the direction of arrow βagainst the force of the spring 133, the pusher 135 is moved forward,pushing the switching member 137 in the same direction. When the member137 reaches a position where the grooves 138 are not located, the pusher135 is rotated until its cam surfaces 135a are aligned with the camsurface 137a of the switching member 137, eliminating the 1/4-pitchdisplacement with respect to the cam surface 1237a.

As the handle 7 is further squeezed in the direction of arrow β, theswitching member 137 is biased backward by the bias spring 136. The camsurfaces 139a of the guides 139 thereby abut on the cam surface 138aformed in the grooves 138, whereby the switching member 137 is rotatedby 90°, making each guide 139 slide into the next groove 138. Thus, themember 137 is intermittently rotated as the handle 7 is squeezed, eachtime through an angle of 90° .

The rear end portion of the right staple pusher 791 is located outsidethe axis of the operation section 1, whereas the rear end portion of theleft staple pusher 79m is located inside the axis of the operationsection 1. As described above, the switching member 137 isintermittently rotated, each time by 90°, as the handle 7 is squeezed.Hence, the outer pusher 140 and one of the inner pusher 141 alternatelyabuts on the rear end of the staple pusher 79.

It will now be described how the stapler shown in FIG. 46 is manipulatedto stitch body tissues together.

FIGS. 45B and 45C show the insertion section 2 and explain how staples22 are loaded in the section 2. When the staple-driving handle 7 issqueezed, the pusher 135 is moved forward, pushing the switching member137 in the same direction. The outer pusher 140 pushes the right staplepusher 791 toward the distal end of the insertion section 2.

In the staple outlet 78a, a staple 22, which has been pushed up from thefront end of the staple track 74, is pressed onto the V-shaped portion82a of the release spring 82. At this time both the anvil 81 and therelease spring 82 connected together. Hence, the anvil 81 is movedtoward the distal end of the insertion section 2.

Thereafter, the projection 81b protruding from the upper surface of theanvil 81 abuts on the front edge of the groove 73a formed in the bottomof the anvil-holding groove 73. The anvil 81 is thereby stopped. Theright staple pusher 791 and the staple 22 are further moved toward thedistal end of the section 2. Then, the release spring 82 is pushed awayfrom the middle portion of the staple 22, and the middle portion of thestaple 22 abuts on the flange 81c.

As the right staple pusher 791 further moves toward the distal end ofthe section 2, it deforms the arcuate leg 22a of the staple 22. When thehandle 7 is completely squeezed, it no longer exerts force to the rightstaple pusher 791. Although the return spring 130 biases the pusher 791backward, the pusher 791 is held at the staple-deforming position by theclaw 76d of the staple-holding plate 76.

When the staple-driving handle 7 is squeezed again in the direction ofarrow β, the switching member 137 is rotated by 90° around its axis,whereby one of the inner pusher 141 abuts on the left staple pusher 79m,exerting a force on the pusher 79m. The left staple pusher 79m is movedforward, deforming the arcuate leg 22b of the staple 22.

While the pusher 79m is deforming the leg 22b of the staple 22, it isheld at the staple-deforming position by the claw 76d of thestaple-holding plate 76, whereas the right staple pusher 791 is releasedfrom the claw 76d. As the handle 7 is released, any force is no longerapplied to the left staple pusher 79m. Thus, the release spring 82pushes down the staple 22 now deformed, whereby the staple 22 is ejectedthrough a staple-ejecting groove 6. Both staple pushers 791 and 79m aremoved backward to their initial positions.

During the staple-deforming process, a high-frequency current issupplied from a high-frequency cautery device (not shown) to theelectrode E via the connecting pin 32 and the electric conductor 31. Thecurrent flows through the staple 22 which contacts the electrode E.Thus, the legs 22a and 22b of the staple 22 are readily deformed,stitching body tissues together.

After the staple 22 has been deformed, both staple pushers 791 and 89mmove backward, returning to their initial positions, by virtue of theforce of the return spring 130. The projection 79b of the right staplepusher 791 abuts on the rear edge of the slit 81a of the anvil 81,whereby the anvil 81 is moved backward, too. The pusher 791 and theanvil 81 are moved backward until the projection 81b of the anvil 8contacts the rear edge of the groove 73a formed in the bottom of theanvil-holding groove 73. The time the pusher 791 and the anvil 81 arestopped, the staple outlet 78a is opened. Then, the next staple 22 ispushed up due to the spring force of the distal end portion of thestaple track 74, and are located in front of both staple pushers 791 and79m.

To apply a staple 22 to target tissues, the distal end of the insertionsection 2 is moved, placing the staple-ejecting opening 70a at the gapbetween the tissues A and b, as is shown in FIG. 49A. Next, thestaple-driving handle 7 is squeezed, pushing the right staple pusher 791forward. Thus pushed, the pusher 791 bends the leg 22a of the staple 22as shown in FIG. 49B, driving the leg 22a into the tissue a. Then, theinsertion section 2 is moved sideways, pulling the tissue a into contactwith the tissue a. Next, the handle 7 is squeezed again, thrusting theleft staple pusher 79m forward. The pusher 79m bends the leg 22b of thestaple 22, driving the same into the body tissue b, as is illustrated inFIG. 49C. As a result, the tissues are stapled together. The staplerenables a surgeon to gather the tissues a and b, without using forceps.Since nothing protrude from the distal-end face of the section 2, thewound to be stapled can be seen well.

A modification of the stapler shown in FIG. 46 will be described, withreference to FIG. 51. As shown in FIG. 46, the modified stapler has aswitching lever 142 rotatably connected to the operation section 1. Thelever 142 is operated to switch the staple-deforming between two modes.The first mode is to deform the legs 22a and 22b of a staple 22 oneafter another, and the second mode is to deform the legs 22a and 22b atthe same time. More precisely, when the lever 142 is operated, selectingthe first mode, the staple pushers 791 and 79m are left separated; whenthe lever 142 is operated, selecting the second mode, the staple pushers791 and 79m are coupled together. The first mode is preferable in thecase the tissues a and b are spaced apart and one needs to be pulledinto contact with the other. The second mode is desirable in the casewhere the tissues a and b contact each other.

A modification of the staple pusher 79 will be described with referenceto FIG. 52 and FIGS. 53A to 53D. As FIG. 52 shows, the modified staplepusher 79 comprises three components, i.e., a right staple pusher 79g, aleft staple pusher 79h, and a center staple pusher 79i. The pushers 79gand 79iare connected by a spring 114a, and the pushers 79g and 79h areconnected by a spring 144b.

In operation, the center staple pusher 79iis moved forward as shown inFIG. 53A, until the pusher 79iand the flange 81c clamp the middleportion of a staple 22 as illustrated in FIG. 53B. Next, the rightstaple pusher 79g is pulled forward by the spring 144a, bending one leg22a of the staple 22 as is shown in FIG. 53C. Finally, the left staplepusher 79h is pulled forward by the spring 114b, bending the other leg22b of the staple 22 as is illustrated in FIG. 53D.

During this staple-deforming process, a high-frequency current issupplied from a high-frequency cautery device to the electrode E via theconnecting pin 32 and the electric conductor 31. The current flowsthrough the staple 22 which contacts the electrode E. Thus, the legs 22aand 22b of the staple 22 are readily deformed, stitching body tissuestogether.

Since the middle portion of the staple 22 is clamped between the flange81c and the center staple pusher 79i, the legs of the staple 22 can bedeformed more readily than otherwise, and the middle portion of thestaple 22 can be deformed appropriately.

The three stages of deforming the staple 22, i.e., deforming the middleportion, the bending the left leg 22a, and the bending the right leg22b, may be performed to predetermined degrees, by incorporating aratchet mechanism in the operation section 1.

FIG. 54A and 54B show two modifications of the staple 22. This staple 22consists of a middle portion 22c having a curving portion 22d, and twolegs 22a and 22b which extend straight from the ends of the middleportion 22c. The portion 22d is curved in a plane perpendicular to thelegs 22a and 22b.

The modified staple shown in FIGS. 54A and 54B is deformed in thefollowing way by the staple pusher 79 of the type shown FIG. 52. First,the center staple pusher 79i is moved forward as shown in FIG. 55A,until the pusher 79iand the flange 81c clamp the portion 22d of a staple22 as illustrated in FIG. 55B. Next, the right staple pusher 79g ispulled forward by the spring 144a, bending one leg 22a of the staple 22as is shown in FIG. 55C. Finally, the left staple pusher 79h is pulledforward by the spring 114b, bending the other leg 22b of the staple 22as is illustrated in FIG. 55D. Since the center staple pusher 79i fitsin the curving portion 22d, the staple 22 is held in place steadfastly,making it easy to pull a first tissue to a second tissue after the leg22a has been driven into the first tissue.

Another modification of the staple pusher 79 will be described withreference to FIG. 56 and FIGS. 57A, 57B and 57C. This modified pusher 79comprises two staple pusher 79j and 79k which are located one above theother. The upper staple pusher 79j has a U-notch formed in the distalend. The lower staple pusher 79k has an elevated horizontal distal endportion is inserted in the U-notch of the upper pusher 79j. The pushers79j and 79k can slide back and forth. A spring 153 biases the lowerpusher 79k backward with respect to the upper pusher 79j. A spring 154is connected to the rear end of the upper pusher 79j.

In operation, a force is applied from the operation section to thestaple pushers 79j and 79k, moving them forward. First, the projections79aof the upper pusher 79* abut on a staple 22 as shown in FIG. 57A. Asthe pushers 79* and 79k are further driven forward, the projections 78abend the staple 22 as shown in FIG. 57B. Thereafter, only the lowerstaple pusher 79k is moved forward, whereby the distal end 79A of thelower staple pusher 79k bends the staple 22 further as illustrated inFIG. 57C.

Therefore, the staple 22 can gather target tissues firmly as it is bentas shown in FIGS. 57B and 57C. Since the staple 22 is bent in twostages, first by the upper staple pusher 79j and then by the lowerstaple pusher 79k, the tissues can be gathered even if they are spacedapart for a relatively long distance. In other words, the staple pusher79 shown in FIG. 56 can deform a staple 22 to stitch a wide-openingincision.

A modification of the stapler shown in FIG. 46 will be described withreference to FIG. 58 and FIGS. 59A and 59B. This modified stapler ischaracterized in two respects. First, a guide rod 157 extends throughthe insertion section 2 and protrudes from the distal end of the section2. Second, a control lever 159 is rotatably connected to the operationsection 1, to move the guide rod 157 back and forth to change thedistance over which the rod 157 protrudes from the section 2.

If the body tissues to staple together are thick, the guide rod 157 isprojected longer from the section 2. If the tissues are thin, the guiderod 157 is projected short from the section 2. The guide rod 157 and thelever 159 serve to staple living tissues of various thicknesses. A scalemay be mounted on the guide rod 157 so that the distance between thetissues and the distal end of the insertion section 2 may be measured.

Still another modified staple pusher 79 will be described with referenceto FIGS. 60A, 60B, and 60C. This modified staple pusher 79 ischaracterized in two respects. First, a member 161 is moved back andforth to change the form in which to bend a staple 22. Second, theflange 81c has a U-notch 163 opening to the member 161. By changing thedistance by which the member 161 is thrust into the U-notch 163, thestaple pusher 79 can bend the staple 22 bent in various shapes, thusadjusting the lengths of the legs 22a and 22b of the staple 22, as canbe understood from FIGS. 60A, 60B, and 60C.

With reference to FIG. 61, a modified staple 22 will be described. Asshown in FIG. 61, the staple 22 consists of two legs 22a and 22b and amiddle portion 22c connecting the legs 22a and 22b. Each leg has a sharptip. The middle portion 22c has a section 22e bulging in the directionopposite to the direction in which the legs 22a and 22b extend.

FIG. 62A shows a modified staple pusher 79. The pusher 79 has a groove167 extending in the axial direction, and a U-notch formed in the distalend. A member 161 is fitted in the groove 167. The member 161 can bemoved into and out of the U-notch of the pusher 79, virtually changingthe depth of the U-notch. In accordance with the depth of the U-notchthus changed, the lengths of the legs 22a and 22b of the staple 22 (FIG.61) are changed as the staple 22 is deformed by the pusher 79. Thus, thestaple pusher 79 serves to staple living tissues of various thicknesses.

A modification of the stapler shown in FIG. 46 will be described withreference to FIG. 63 and FIGS. 64A to 64D. In this modified stapler, apusher 135 has a thin, plate-like distal end portion. The pusher 135 isheld by a holder 104 and can be moved along the length of the operationsection 1. The holder 104 protrudes of the inner surface of the frame 1aof the section 1. A streamline member 100 is connected to one end of aleaf spring 101 by a pin 102 and can rotate around the pin 102. Theother end of the leaf spring 101 is fastened to the frame la by a pin103. The leaf spring 101 is normally arching upwards as shown in FIG.63. Two guides 105 extend parallel to the axis of the operation section1--one above the member 100 and the spring 101 and the other below themember 100 and the spring 101. These guides 105 guide the distal endportion of the pusher 135 toward the staple pusher 79.

The operation section 1 is manipulated in the following manner. When thehandle 7 is squeezed in the direction of arrow β, the pusher 135 ismoved forward. The distal end of the pusher 135 abuts on the upper sideof the streamline member 100 as is shown in FIG. 64A. As the pusher 135is further moved forward, its distal end comes to contact the rear endof the right staple pusher 791, pushing the pusher 791 forward. Thepusher 791 bends the right leg of a staple. At this time, the pusher 135presses and bends the leaf spring 101 downward as shown in FIG. 64B.Next, the staple-driving handle 7 is released, and the spring 133rotates the handle 7 in the direction opposite to arrow β, therebymoving the pusher 135 backward. The leaf spring 101 remains bentdownward, and the streamline member 100 remains inclined upward. Then,the handle 7 is squeezed again in the direction to arrow A, making thepusher 135 abut on the lower side of the streamline member 100 as isillustrated in FIG. 64C. As the pusher 135 is further moved forward, itabuts on the rear end of the left stapler pusher 79m. The pusher 79m isthereby thrust forward, bending the left leg of the staple as is shownin FIG. 64D. At this time, the pusher 135 presses and bends the leafspring 101 upwards. Thus, the leaf spring 101 is set in the initialstate. Even if the handle 7 is released, the spring 101 remains in thisstate.

Hence, every time the staple-driving handle 7 is squeezed and released,the pusher 135 moves the two staple pushers 791 and 79m alternately,making them deform a staple.

A stapler according to a fourth embodiment of the present invention willbe described, with reference to FIG. 65, FIGS. 66A to 66C, and FIGS. 67to 73.

AS shown in FIG. 65, the stapler comprises an operation section 1, aninsertion section 2 coupled to the distal end of the operation section1, and a stapling member 5 connected to the distal end of the insertionsection 2. The stapling member 5 has a cartridge 3 and an anvil 4. Theoperation section 1 has an operating member 6, a staple-driving handle7, a connecting pin 32, and a switch S. The operating member 6 can bepulled and pushed to open and close the stapling member 5. Theconnecting pin 32 can be connected to a high-frequency cautery device(not shown). The switch W is operated to supply a high-frequency currentfrom the cautery device to the stapling member 5 and to shut off thecurrent supplied from the cautery device.

As shown in FIGS. 67 to 69, cutter-guiding grooves 18 and 19 are formedin the inner surface of the cartridge 3 and that of the anvil 4,respectively, extending along the center lines of the cartridge 3 andthe anvil 4. A cutter 29 is slidably inserted in the grooves 18 and 19,for cutting an tissue A held between the cartridge 3 and the anvil 4.

As shown in FIG. 67, the cartridge 3 contains a stapling unit 211 and athread-applying unit 212. The stapling unit 211 is located on one sideof the cutter-guiding groove 18, and the thread-applying unit 212 on theother wide of the groove 18.

As shown in FIG. 69, the stapling unit 211 has slits 21 arranged instaggered fashion in two rows. That is, any slit of one row overlaps theends of the adjacent two slits of the other row. As shown in FIG. 70,pushers 21a are slidably placed in the slits 21, respectively, and canprotrude upward from the inner surface of the cartridge 3. U-shapedstaples 22 are inserted in the slits 21 and mounted on the pushers 21a,respectively, each with its legs 22a and 22b extending upwards. A pairof plate-guiding grooves (not shown) extend within the cartridge 3 alongthe row of slits 21. A pair of pusher plates 24 can be moved back andforth along the plate-guiding grooves.

As is shown in FIG. 68, grooves 25 are formed in the inner surface ofthe anvil 8. The grooves 25 are arranged in staggered fashion in tworows; they are so positioned as to meet the slits 21 of the staplingunit 211 when the inner surface of the anvil 4 contacts that of thecartridge 3. Each of these grooves 25 has an arcuate bottom so that thelegs 22a and 22b of a staple may be bent inward and toward each otherwhen they are pressed against the bottom of the groove 25.

The thread-applying unit 212 has an elongated recess 217 formed in theinner surface of the cartridge 3 and extending substantially parallel tothe cutter-guiding groove 18. Teeth 219 are mounted in the recess 217,spaced apart equidistantly.

Teeth 218 are mounted on the inner surface of the anvil 4. They are solocated as to contact the teeth 219 when the inner surface of the anvil4 contacts that of the cartridge 3. Hence, when the stapling member 5 isclosed, the teeth 218 of the anvil 4 abuts on those 219 of the cartridge3 as is shown in FIG. 71. A target tissue A is thereby clamped betweenthe row of teeth 218 and the row of teeth 219, and parts of the tissue Abulge in the spaces 218a among the teeth 218 and the spaces 219a amongthe teeth 219.

As shown in FIGS. 68 and 69, each tooth 218 has a thread-guiding groove220, and each tooth 219 has a thread-guiding groove 221. The grooves 220form a thread passage, the rear end of which communicates with one endof a flexible guide pipe 222. Similarly, the groove 221 form a threadpassage, the rear end of which communicates with one end of a flexibleguide pipe 223. The flexible pipes 222 and 223 are connected at theother end to a channel port 224 which is formed in one side of theoperation section 1 as shown in FIG. 62. A tying thread 226 is insertedthrough the channel port 224 into the thread passages defined by thegroove 220 and 221.

As is shown in FIG. 72, the channel port 224 has a pair of wire-guidingholes 224a and 224b. The port 224 also has a thread-guiding slit 224cconnecting the holes 224a and 224b. The insertion section 2 has twothread-guiding holes--one extending between the hole 224a and the guidepipe 222, and the other extending between the hole 224b and the guidepipe 223.

As shown in FIG. 65, a tying thread 226 is fastened at its ends to theread ends of two guide wires 225. The guide wires 225 are insertedthrough the holes 224a and 224b, the thread-guiding holes formed in thesection 2 and the flexible pipes 222 and 223 into the thread passagesformed in the stapling member 5.

The stapler shown in FIG. 65 is manipulated in the following way. Anincision is formed in a body wall such as the abdominal wall. Thestapling member 5 and the insertion section 2 are inserted into a bodycavity through the incision. The insertion section 2 is further pushed,thus moving the stapling member 5 toward the target tissue A. Theoperating member 6 is pulled, opening the stapling member 5. The member5 is further moved until it catches the target tissue A. Then, theoperating member 6 is pushed, closing the stapling member 5. The tissueA is thereby clamped between the cartridge 3 and the anvil 4. At thistime, the teeth 218 of the anvil 4 press the tissue A onto the teeth 219of the cartridge 3. Those parts of the tissue A, which are not clampedbetween the teeth 218 an 219, bulge in the spaces 218a and 219a amongthe teeth 218 and among the teeth 219, as is illustrated in FIG. 71.

In this condition, the staple-driving handle 7 is squeezed in thedirection of arrow β, the pusher plates 24 are moved forward along theplate-guiding grooves, and the knife unit 29 are moved forward along thewire cutter-guiding grooves 18 and 19. As the pusher plates 24 moveforward, their inclining distal ends 24a push up the pushers 21asequentially, ultimately driving the staples 22 into the tissue A, oneafter another. The legs 22a and 22b of each staple 22 pierce the wall ofthe tissue A, abut on the bottom of the groove 25 formed in the innersurface of the anvil 4, and have their tips bent inwardly. As a resultof this, the stapling unit 211 stitches the tissue A with the staples 22arranged in two parallel rows.

Immediately after the tissue A is stitched, the cutter 29, which ismoving forward along the grooves 18 and 19, severs the tissue A.Immediately before the cutter 29 cuts the tissue A, a high-frequencycurrent is supplied from a cautery device (not shown) to the wire-cutter29 via a cable (not shown) connected to the connecting pin 32.Therefore, the tissue A is cauterized while being severed, and there isno risk of bleeding at the severed portions of the living tissues A.

Then, the guide wires 225 are inserted through the holes 224a and 224bof the channel port 224, thus guiding the tying thread 226 into theoperation section 1. Further, the wires 225 are inserted through thethread-guiding holes formed in the section 2 and the flexible pipes 222and 223 into the thread passages formed in the stapling member 5. As aresult, the half of the thread 226 is guided into the passage defined bythe groove 220 of the teeth 218 of the anvil 4, whereas the remaininghalf of the thread 226 is guided into the passage defined by the grooves221 of the cartridge 3.

One of the guide wires 225 pierces those parts of the tissue H2 locatedin the spaces 219a among the teeth 219 of the cartridge 3, while theother guide wire 225 pierces those parts of the tissue H2A located inthe spaces 218a among the teeth 218 of the anvil 4. The tips of thewires 225, which protrude from the tissue H2, are held by forceps or thelike and then pulled from the distal end of the stapling member 5. As aresult, both halves of the tying thread 226 pass through the bulgingparts of the tissue H2 located in the spaces 218a and 219a, stitchingthe edge of the tissue H2 severed from the tissue A.

Then, the operating member 6 is pulled, opening the stapling member 5.The stapled tissue A and the stitched tissue H2 can thereby be removedfrom the nip between the cartridge 3 and the anvil 4, as is shown inFIG. 73.

As described above, the staples 22 are driven into the tissue A by meansof the sapling unit 211 located on one side of the cutter-guidinggrooves 18 and 19, thus stapling together the opposing walls of thetissue A. Next, the cutter 29 is operated, severing the tissue into twoportions. Thereafter, the thread-applying unit 212 located on the otherside of the grooves 18 and 19 is operated, stitching the edge of thetissue portion H2 with the tying thread 225. Thus, the stapler shown inFIG. 65 can apply not only staples 21 but also a tying thread 226.Therefore, the stapler enables a surgeon to staple the opposing walls ofa tubular tissue A and stitch the severed edge of a tubular tissue H2with the tying thread 226, with ease and efficiency, after affectedtissues have been removed from the tissue.

FIGS. 74 to 75, FIG. 77A and 77B, and FIG. 78 show a modification of thethread-applying unit 212. As is shown in FIGS. 74 and 75, staples 22,with a single tying thread 232 wound around them, are placed in thespaces 218a among the teeth 218 of the anvil 3 and the spaces 219a amongthe teeth 219 of the cartridge 3. The legs 22a and 22b of each staple 22are inclined toward each other, and one turn of the thread 232 ismounted on the middle portion of each staple 22. In other words, thestaples 22 are connected by the typing thread 232.

When the stapling member 5 is closed, a tissue A is clamped between thecartridge 3 and the anvil 3. The staples 22 are thereby driven into thebulging parts of the tissue A which are located the spaces 218a amongthe teeth 218 of the anvil 3 and the spaces 219a among the teeth 219 ofthe cartridge 3. Hence, the staples 22 are secured to the tissue A.

Thereafter, other staples 22 are driven into the tissue A by means ofthe sapling unit 211 located on one side of the cutter-guiding grooves18 and 19. These staplers 22 fasten the opposing walls of the tubulartissue A together. Then, the cutter 29 is operated, severing the tissueinto two portions. Next, the operating member 6 on the operation section1 is pulled, opening the stapling member 5. The tissue A into which thestaples 22 with the thread 232 wound around them have been driven isremoved from the nip between the cartridge 3 and the anvil 4. As shownin FIG. 77A, the thread 232 connects the staples 22. The thread 232 ispulled, tying the severed edge of the tissue A as illustrated in FIG.77B.

Thus, as with the fourth embodiment, a surgeon can not only staple theopposing walls of a tubular tissue A but also stitch the severed edge ofa tubular tissue with the tying thread 232. Also, as in the fourthembodiment, the severed edge of the tubular tissue A can be stitchedwith the tying thread 232, with ease and efficiency, after affectedtissues have been cauterized and then removed from the tissue A.

In addition, the severed edge of the tubular tissue can be stitchedtogether more easily than in the fourth embodiment in which the guidewires 225 are manipulated to apply the tying thread 226 to the severededge of the tissue H2. This is because the thread 232 is applied merelyby driving the staples 22 into the tissue A.

As shown in FIG. 77B, the end portions of the thread 232 are passedtrough two holes of a fastener 234. Then, the end portions of the thread232 are pulled, with the fastener 234 positioned near the severed edgeof the tissue A. The severed edge of the tubular tissue A is therebysqueezed or collapsed with much ease.

The anvil 233 of a stapler designed to fasten a tubular tissue may beinserted into the tubular tissue A from the severed edge as isillustrated in FIG. 78. In this case, the severed edge of the tissue Acan easily be fastened to the severed edge of another tubular tissue bymeans of the stapler.

A stapler according to a fifth embodiment of the present invention, willbe described with reference to FIGS. 79, 80, and 81.

As FIG. 79 shows, this stapler comprises an operation section 251 and aninsertion section 252 connected at its proximal end to the operationsection 251. The operation section 251 has a pair of handles 253, anadjustment screw 254, and a connecting pint 32. A cylindrical staplereceptacle 257 is coupled to the distal end of the insertion section252. The receptacle 257 contains a plurality of U-shaped staples 22arranged in a circle.

An anvil shaft 258 extends through the insertion section 252 and thestaple receptacle 257--coaxial therewith. A connecting screw 259 isconnected to the distal end of the anvil shaft 258. The connecting screw259 can rotate around its axis and can move along its axis; it protrudesfrom the distal end of the receptacle 257. An anvil 260 has connectingrod 261 which has a screw hole 262, in which the connecting screw 259can be fit in screw engagement. The connecting screw 259 is fastened atthe proximal end to the adjustment screw 254 which extends through theinsertion section 252. The screw 259 is electrically connected to theconnecting pin 32 by a cable 31 which extends through the anvil shaft258.

A pusher 264 is located in the staple receptacle 257, for pushing thestaples 22 forward. The pusher 264 can be moved back and forth along theaxis of the receptacle 257. The pusher 264 is connected to the handles253 by a connecting tube 265 which extends through the insertion section252. A hollow cylindrical cutter 266 is located in the staple receptacle257, surrounded by the staple 22 arranged in a circle. The cutter can bemoved along the axis of the receptacle 257.

The connecting pin 32 is connected to the connector 34 coupled to oneend of a cable 33. The other end of the cable 33 is connected to acautery device 35.

The stapler shown in FIG. 79 is operated in the following way to applythe staples 22 to the abutting ends of tubular tissues, thereby tofastening the tubular tissues.

First, a tubular tissue A is positioned between the staple receptacle257 and the anvil 260, and the anvil 260 is inserted into anothertubular tissue b, with the connecting rod 261 protruding from the closedend of the tissue b. While applying a high-frequency current to theconnecting screw 259, the screw 259 is thrust into the end wall of thetissue A and subsequently pierces the end wall of the tissue a. Then,the screw 259 is inserted into the screw hole 262 of the connecting rod261 which pierces the end wall of the tissue b and protrudes therefrom.The connecting screw 259 is rotated around its axis until it is set inscrew engagement with the connecting rod 261.

Next, the adjustment screw 254 is rotated, rotating the connecting screw259 and moving the same back and forth, thereby adjusting the distancebetween the receptacle 257 and the anvil 260. Then, the handles 253 aresqueezed, thrusting the pusher 264 forward. The pusher 264 pushes anddrives the U-shaped staples 22 into the abutting walls of the tissues aand b. The legs of each U-shaped staple 22 abut on the anvil 260 and arebent toward each other. As a result, the walls of the tubular tissues aand b are stitched together. The cylindrical cutter 266 is thrustforward, cutting off the unnecessary inner parts of the stapled walls.

As described above, a high-frequency current is supplied to theconnecting screw 259, whereby the end wall of the tissue a is cauterizedand becomes easy to pierce. The screw 259 can therefore easily piercethe wall of the tissue a. Even if the screw 259 pierces a blood vessel,if any in the cauterized portion, there will be no bleeding because theblood vessel has been cauterized, too. No sharp stylus needs to beattached to the distal end of the connecting screw 259. The stapler hasimproved operating efficiency.

A clip applicator 271, which is a sixth embodiment of the presentinvention, will be described with reference to FIGS. 82 and 83.

The clip applicator 271 has a clip receptacle (not shown) which containsa plurality of 272. As shown in FIG. 82, the clip applicator 271comprises an operation section 273 and an insertion section 274. Theoperation section 273 has a handle 275, a switch 276, and a connectingpin 32. The pin 32 is electrically connected to a high-frequency cauterydevice (not shown) by a cable 33.

Jaws 279 are connected to the distal end of the insertion section 274.The Jaws 279 can be opened and closed by operating the handle 275. Whenclosed, the jaws 279 deform a clip 272 already held between them,thereby to ligate a blood vessel or the like.

The frame of the operation section 274, the insertion section 274, andthe handle 275 are made of electrically insulating material such asplastics. The jaws 279 are made of electrically conductive material suchas stainless steel. As can be understood from FIG. 83, the jaws 279 iscoated with an insulating film 280, such as Teflon coating, ceramiccoating, paint, or the like--except for the inner surface which contactsthe clip 272.

The clip applicator is operated in the following way. After a bloodvessel to ligate is placed in the gap between the legs of the clip 272loaded between the jaws 279, the handles 275 are squeezed, closing thejaws 279. The clip is thereby deformed plastically, clamping the bloodvessel. In this condition, the switch 276 is operated, supplying ahigh-frequency current to the clip 272 through the jaws 279 andsubsequently cauterizing the clamped portion of the blood vessel. Theclip applicator is operated again in the same way, thus deforming clips272, clamping another portion of the blood vessel, and cauterizing thisportion. Thereafter, that portion of the blood vessel which extendsbetween the clamped by the clips 272 is cut off.

The blood vessel is clamped by virtue of the plastic deforming of theclip 272, thus stopping the blood flow in the vessel. Then, the clampedportion of the blood vessel is cauterized with a high-frequency current.Hence, there is no bleeding at the clipped portion of the blood vessel.Should the clip 272 slips from, or is removed by mistake from, the bloodvessel during a surgical operation, no bleeding will occur at theclipped portion because this portion has been cauterized.

FIG. 84 shows a modification of the clip applicator 271. As isillustrated in FIG. 84, the jaws 279 has non-insulating tips 281. Thesetips 281 may either monopolar or bipolar. Bleeding occurs unexpectedlyin the process of inserting the insertion section 274 into a bodycavity. To stop such bleeding, it suffices to set the non-insulatingtips 281 in contact with the bleeding tissues and to operate the switch276. When the switch 276 is closed, a high-frequency current is suppliedto the bleeding tissues via the non-insulating tips 281, cauterizing thetissues. Once cauterized, the tissues stops bleeding. The Jaws 279having a non-insulating tip 281 each can be utilized not only toaccomplish hemostasis, but also to peel tissue layers.

Hence, should any tissues start bleeding while the insertion section 274is being inserted into a body cavity, the section 274 need not beimmediately pulled from the body cavity and a high-frequency forcepsneed not be inserted into the body cavity at once. The modified clipapplicator enables a surgeon to perform prompt and timely hemostasis,increasing the efficiency of surgical operations.

FIG. 85 shows a second modification of the clip applicator. As can beunderstood from this figure, each jaw 279 of this modified clipapplicator have two recesses, an insulating body 282 embedded in theinner surface, and an electrode blade 283 held by the insulating body282. Hence, a pair of clips 272 can be held between the jaws 279.

The modified clip applicator is operated as follows. First, a bloodvessel to ligate is placed between the legs of the clips 272 held by thejaws 279. This done, the handles 275 are squeezed, closing the jaws 279.The clips 272 are thereby plastically deformed, clamping or ligating theblood vessel. Next, the switch 276 is operated, supplying ahigh-frequency current to both electrode blades 283. The electrodeblades 283 heat and cut that portion of the blood vessel which islocated between the clips 272.

With the modified clip applicator it is possible to apply two clips 272to a tubular tissue at a time. In addition, hemostasis is achieved atthe severed edges of the tissue since the electrode blades 283 cut thetissue by using a high-frequency current. Even if the clips 272 clampthe tissue less tightly than desired, no hemostatic measures need to betaken. The high-frequency current may be so reduced as to cauterize thatportion of the blood vessel which is located between the clips 272,instead of cutting that portion of the blood vessel. In this case, too,reliable hemostasis can be accomplished.

A third modification of the clip applicator (the sixth embodiment) willbe described with reference to FIGS. 86 and 87. As shown in FIG. 86, ajaw-operating handle 275 is rotatably connected to the frame 273 of theoperation section. As shown in FIG. 87, the jaws 279 can hold two clips272 at a time. Each jaw 279 has a groove formed in the inner surface ofits distal end portion. The grooves of the jaws define a blade passage.Located in the blade passage are a pair of electrode blades 283connected to a blade-operating handle 284 which is rotatably coupled tothe operation section.

The modified clip applicator shown in FIG. 86 is operated in thefollowing way. A blood vessel to ligate is placed between the legs ofthe clips 272 held between the jaws 279. Then, the handle 275 isoperated, closing the jaws 279. Both clips 272 are thereby deformedplastically, clamping the blood vessel at two portions. In thiscondition, the switch 276 is operated, whereby a high-frequency currentis applied to the clips 272 via the jaws 279. While supplying thecurrent to the clips 272, the blade-operating handle 284 is operated,moving both electrode blades 283 forward. The electrode blades 283,which have a sharp edge each, can cut the blood vessel well.

A modified stapling member will be described with reference to FIGS. 88and 89. As is shown in FIG. 89, the stapling member comprises acartridge 3 and an anvil 4. The cartridge 3 has a cutter-guiding groove18 formed in its inner surface as is illustrated in FIG. 88. Three rowsof slits 21a, 2lb and 21c are formed in the inner surface of thecartridge 3 on either side of a cutter-guiding groove 18. Hence, thecartridge 3 has six rows of slits formed in its inner surface. Insertedin these slits are staples 21 which can be moved up and down. Pushers21a are located below the staples 21 and can be moved vertically. Eachpusher 21a is wide enough to simultaneously contact three adjacentstaples 21r, 21m, and 211 which are arranged side by side. Four pusherplates 24 extend through the cartridge 3 along the length thereof andparallel to each other--two located on one side of the cutter-guidinggroove 18, and the remaining two on the other side of the groove 18. Thepusher plates 24 can be moved back and forth at the same time for thesame distance. The two pusher plates 24 on each side of the groove 18abut on the lower side of each pusher 21a as they are thrust forward.The pushers 21a, the staples 22, and the pusher plates 24 are made ofelectrically conductive material such as metal. By contrast, thecartridge 3 and the anvil 4 are made of electrically insulatingmaterial.

The modified stapling member further comprises an operation section (notshown). The operation section has a connecting pin which is electricallyconnected to the pusher plates 24 at one end. The other end of theconnecting pin can be connected to a high-frequency cautery device, asin the fourth embodiment (FIG. 65). Hence, a high-frequency current canbe supplied to the pusher plates 24.

With this modified stapling member, a high-frequency current is suppliedto all staples driven into a tubular organ being stapled, such asintestine. Hence, hemostasis can be accomplished at the same time theorgan is stitched and an unnecessary part thereof is cut off.

The high-frequency current may be supplied some of the staples, not toall of them. For instance, the current can be supplied to only thestaples 22 inserted in the center row of slits 211 if the pushers 21alocated below the outer rows of slits 21m and 21r are made ofelectrically insulating material.

The pushers 21a need not be made electrically conductive material forthe purpose of supplying the high-frequency current to the staples 22.Rather, the cartridge 3 and the anvil 4 may be made of conductivematerial, and the high-frequency current may be supplied from thehigh-frequency cautery device.

A stapler according to a seventh embodiment of the invention will bedescribed with reference to FIG. 90 through FIG. 95.

This stapler is similar to the first embodiment (FIGS. 1 to 12) in thatthe cartridge 3 curves, as evident from FIG. 90, in a planeperpendicular to the direction of ejecting staples. The staplerbasically differs from the first embodiment in that pushers 300 and 301which correspond to the pusher plates 24, and a cutter 302 whichcorresponds to the wire cutter 20 are located in the cartridge 3, notincorporated in the insertion section (not shown).

The pushers 300 and 301 and the cutter 302 are connected to wires 303,304, and 305 which are connected at the proximal end to a connector 306.The pushers 300 and 301, the cutter 302, the wires 303 to 305, and theconnector 305 are made of flexible material and constitute a flexibleassembly 314. The assembly 314 is rotatably coupled to the insertionsection by means of an annular groove 307 formed in the circumference ofthe connector 306 and a pin (not shown) protruding from the distal endof the insertion section.

The cartridge 3 can be removably coupled to the insertion section.Instead, it may be secured to the insertion section. If so, theconnector 305 can be dispensed with, and the wires 303 to 305 extendthrough the insertion section and connected to the constituent membersof the operation section (not shown).

The pushers 300 and 301 can be moved back and forth along guide grooves308 and 309 formed in the inner surface of the cartridge 3. Similarly,the cutter 302 can move back and forth along the cutter-guiding groove18 formed in the inner surface of the cartridge 3. The wires 303,304,and 305 can be pulled and pushed through guide holes 311,312 and 313made in the cartridge 3, as is shown in FIG. 94. The connector 306 canalso move along the length of the cartridge 3 through the guide hole 315made in a member 317 located in the proximal end portion of thecartridge 3.

The guide grooves 308 and 309 and the guide holes 311 to 313 extendparallel to the curving axis of the cartridge 3. Nonetheless, theflexible assembly 314, which is composed of the pushers 300 and 301, thecutter 302, the wires 303 to 305, and the connector 305, can smoothlymove back and forth because of its own flexibility.

The wires 303, 304, and 305 may be stranded stainless-steel wires. Theyare guided by flexible guides (not shown) which are, for example, tubesor coils.

As shown in FIG. 90, staple-ejecting slits 21 are formed in the innersurface of the cartridge 3. The slits 21 are arranged in four rows--twolocated on one side of the cutter--guiding groove 18, and the other twolocated on the other side of the groove 18. The slits 21 of the two rowson either side of the groove 18 are so positioned that any of one rowoverlaps the adjacent two of the other row. All slits 21 have the samelength, and staples of the same size are driven through these slits 21.Instead, the slits 21 of the outer row on either side of thecutter-guiding groove 18 may be longer than those of the inner row, sothat longer staples may be ejected through the slits 21 of the outerrow.

As is shown in FIG. 95, the stapler can be used in combination with atrocar 314 which comprises a cap 315 and a sheath 316 connected to thecap 315. The sheath 316 is made of, for example, PTFE and is flexibleenough to bend as much as the cartridge 3 is curving. Although notshown, a valve means is attached to the proximal end of the trocar 314,for prevent the leakage of gas from the body cavity into which thesheath 316 has been inserted. Instead, the valve means may be removalcoupled to the flexible sheath 316.

As shown in FIG. 95, the cartridge 3 is connected to an anvil 4,constituting a stapling member 5. To insert the stapling member 5 into abody cavity, it is closed and then inserted into the trocar 314. Beingflexible unlike the convention rigid ones, the sheath 316 of the trocar314 bends as the member 5 is gradually inserted into it, allowing thepassage of the stapling member 5. Thus, the stapling member 5 can besmoothly inserted into a body cavity through the trocar 314. Thereafter,the stapler is manipulated in the same way as the first embodiment.

As is shown in FIGS. 96 and 97, the pushers 300 and 301 and the cutter302 may be secured to a base 320 made of elastic material. The distalend of this base 320 is connected to the distal end of a wire 321. Theproximal end of the wire 321 is connected to the connector 306. Themiddle portion of the wire 321 is wrapped around a pulley 322 which isrotatably supported. When the connector 306 is pulled backward, thepushers 300 and 301 and the cutter 302 are thrust forward, to ligate andcut body tissues.

A modification of the stapler of the seventh embodiment will bedescribed with reference to FIGS. 98 and 99.

FIGS. 98 and 99 show a modification of the cartridge 3. The modifiedcartridge also curves in a plane perpendicular to the direction ofejecting staples. As can be understood from FIG. 99, the pushers 300 and301 and the cutter 302 have a lower side arcuated with same curvature asthe cartridge 3. (In FIG. 99, only the pusher 300 is shown.) The wires303, 304, and 305 are connected to the pusher 300, the pusher 301, andthe cutter 302, respectively, by pins so that each of these components300, 301 and 302 may rotate around the pin.

Having a curving stapling member 5, the stapler according to the seventhembodiment is advantageous in three respects. First, it can easilyapproach a position where the target tissues are located. Second, themember 5 can be easily moved to hold an organ existing on the bottom ofthe abdominal cavity or the chest cavity. Third, the distal end of thecartridge can be seen well through an endoscope, enabling a surgeon tosee whether or not that portion of the organ to which he or she wants toapply staples is located inside the distal end portion of the cartridge.Therefore, the stapler can help the surgeon to achieve successfulintra-cavity operations.

Generally, the insertion section of the stapler can be either rigid orflexible. If rigid, it can be straight or curving. If the insertionssection is a curving or flexible one, the components (e.g., the wires303) extending through it from the operation section, for operating thestapling member 5, may be made of flexible material so that they canbend, too. Also, the members guiding these components may be flexibleones such as tubes and coils.

Another stapler, which is an eighth embodiment of the invention, will bedescribed with reference to FIG. 100, FIGS. 101A and 101B, and FIGS. 102and 103.

As clearly shown in FIG. 100, a lever 430 and a handle 431 are rotatablyattached to the frame 432 of the operation section. An insertion section433 is connected at the proximal end to the frame 430. Coupled to thedistal end of the insertion section 433 is a stapling member 5 whichcomprises a cartridge 3 and an anvil 4. The anvil 4 is connected to thecartridge 3 by a pin 436 and can rotate around this pint 436. Thecartridge 3 and the anvil 4 curve in the same direction. The cartridge 3has grooves for guiding pusher plates. These grooves curve along thelength of the cartridge 3. Pusher plates 24 are placed in the groovesand made of flexible material so that they may move along the curvinggrooves.

The anvil 4 is connected to the lever 430. When the lever 430 is rotatedin the direction of the arrow shown in FIG. 100, the anvil 4 is rotatedaround the pin 436 in the direction of the arrow shown in FIG. 101A. Thepusher plates 24 are connected to the handle 431. When the handle 431 issqueezed in the direction of arrow β as shown in FIG. 100, the pusherplates 24 are thrust forward and push up pushers 21a which are shown inFIG. 103. Thus pushed, the pushers 21a drive staples 22.

The stapler shown in FIG. 100 is operated in the following way to staplebody tissues and cut unnecessary parts thereof. First, the lever 430 isrotated in the direction opposite to the arrow shown in FIG. 100,thereby opening the stapling member 5. The stapler is moved, placingtissues A (e.g., lung tissues) in the gap between the cartridge 3 andthe anvil 4 as is illustrated in FIG. 101A. The lever 430 is rotated inthe direction of the arrow (FIG. 100), rotating the anvil 4 in thedirection of the arrow (FIG. 101A). The tissues A are thereby clampedbetween the cartridge 3 and the anvil 4. Next, the handle 431 issqueezed, moving the pusher plates 24 forward along the curving grooveformed in the inner surface of the cartridge 3. Thus moved, the plates24 push the pushers 21a upwards, whereby the pushers 21a drive thestaples 22 into the tissues A clamped between the cartridge 3 and theanvil 4. As a result, the tissues are stitched together. In themeantime, the cutter (not shown) is moved forward through the cartridge3 and the anvil 3, cutting off unnecessary parts of the tissues A.

The resultant stitch line curves as indicated by the broken line in FIG.102. This makes it possible to cut off the least parts necessary fromthe clamped tissues. Further, since the cartridge 3 and the anvil 4 areconnected rotatably by the pin 436, they can clamp tissues more firmlythan otherwise. In addition, when the stapling member 5 is closed, theanvil 4 exerts a clamping force uniformly all over the tissues, wherebythe tissues can be stitched together neatly.

A stapler according to a ninth embodiment of the invention will bedescribed with reference to FIGS. 104 to 109. This stapler ischaracterized in that the insertion section 2 has a distal end portionwhich can bend in two directions.

As shown in FIG. 104, the distal end portion of the insertion section 2comprises a plurality of segments 512 and a ring-shaped cam 510. The cam510 is mounted on the foremost segment 512 and can slide back and forth.The segments 512 are hollow cylindrical members, each connected to thenext one by a pair of coaxial pins and able to rotate with respect tothe next one in the plane perpendicular to the direction of ejectingstaples. A pair of elongated leaf springs 511 are slidably mounted onthe sides of the insertion section 2. The leaf springs 511 are connectedat the front end to the cam 510, and at the rear end to a leverrotatably connected to the frame of the operation section (not shown).Hence, when the lever is operated, the cam 510 is moved back and forth.

A cartridge 3 and an anvil 4, constituting a stapling member, arerotatably coupled to a connector inserted in the segments 512. They arebiased by a spring means and to assume open positions. The cam 510performs the same function as the outer tube 9 used in the firstembodiment. That is, the cam 510 presses the cartridge 3 and the anvil 4toward each other when it is pulled backward, and allows the cartridge 3and the anvil 4 to rotate into their open positions when it is pushedforward.

When one of the leaf springs 511 is pulled backward for a predetermineddistance, the distal end portion of the insertion section 2 is bent inone direction. If both leaf springs 511 are further pulled back for thesame direction, the stapling member is opened while the distal endportion of the insertion section 2 remains bent in said one direction.

In the stapler shown in FIG. 104, the cartridge 3 can be removablyattached to the connector inserted in the distal end portion of theinsertion section 2 as is shown in FIGS. 105 to 109. More specifically,as shown in FIG. 105, a thin coiled wire 518 is fastened at the forwardend to a pusher plate 24 inserted in the cartridge 3. The rear end ofthe coiled wire 518 is connected to a first coupling 514 which projectsform the rear-end face of the connector. Also inserted in the cartridge3 is a thick coiled wire 519, through which the thin coiled wire 518extends and is guided. The thick coiled wire 519 constitutes theconnector. As shown in FIG. 106, a second coupling 515 is connected tothe rear end of the coiled wire 519. The second coupling 511 is a hollowcylinder having an annular groove formed in its circumference. The firstcoupling 518 extends through the second coupling 515 and is positionedcoaxial therewith, with its rear end portion protruding from the rearend of the second coupling 515 as illustrated in FIG. 106.

An operating coil spring 590 extends from the frame of the operationsection (not shown) through the insertion section 2, reaching therearmost segment 512 (FIG. 104). As shown In FIG. 107, a firstcylindrical split-spring 516 is fastened to the forward end of theoperation coil spring 590. The first split-spring 516 has such a sizethat the first coupling 514 may fit into it elastically. As shown inFIG. 108, a second cylindrical split-spring 517 is mounted on the firstsplit-spring 516 and positioned coaxial therewith. The secondsplit-spring 517 has such a size that the second coupling 515 may fitinto it elastically. A lever 591 is rotatably connected at one end tothe second split-spring 517 as is shown in FIG. 109. The other end ofthe lever 591 is located below a push button 592 slidably set in a holemade in the wall of the insertion section 2. The push button 592 isbiased upward by a coil spring 593. It is pushed down to release thecartridge 3.

The first coupling 514 and the second coupling 515 are pushed into thefirst split-spring 516 and the second split-spring 517, respectively,against the forces of these springs 516 and 517, whereby the cartridge 3is attached to the distal end of the insertion section 2. To remove thecartridge 3 from the insertion section 2, the button 592 is pushed downagainst the bias of the spring 593, rotating the lever 591. Thusrotated, the lever 591 expands the second split-spring 517, which inturn expands the first split-spring 516. As a result, the cartridge 3can be pulled out of the insertion section 3.

The above-described mechanism connecting the cartridge 3 to theinsertion section 2 enables both coiled wires 518 and 519 can smoothlyrun through the insertion section 2 though the distal end portionthereof is bent. Driven forward by these coiled wires 158 and 519, thepusher plate 24 ejects staples.

A stapler according to a tenth embodiment of the present invention willbe described with reference to FIGS. 110 and 111.

As shown in FIG. 110, the stapler comprises an operation section 699, aninsertion section 2 connected to the distal end of the operation section699, and a stapling member connected to the distal end of the insertionsection 2 and comprising a cartridge 3 and an anvil 4. An anviloperating lever 630, a pusher-plate operating lever 640, and an angleknob 600 are rotatably connected to the operation section 699. The angleknob 600 is connected to the ends of a horizontal pin which extendsthrough the section 699 at right angles to the axis thereof. A pulley602 is fastened to the pin an located within the operation section 699.A wire 603 is wrapped around the pulley 602.

The distal end portion 601 of the insertion section 2 is made flexible.More specifically, as shown in FIG. 111, the portion 601 comprises aplurality of hollow cylindrical segments 604, each connected to the nextone by a pair of coaxial pins and able to rotate with respect to thenext one. The ends of the wire 603 are fastened to the foremost segment604, spaced apart by 180° along the circumference of the segment 604.The distal end portion 601 is covered with a flexible resin sheath 606,whereas the other portion of the insertion section 2 is covered with arigid resin sheath 650.

When the angle knob 600 is rotated back and forth, the pulley 602 isrotated, driving the wire 603 connected at both ends to the foremostsegment 604. The foremost segment 604 is thereby driven forward at oneside and backward at the other wide, whereby the flexible distal endportion 601 is bent by any desired angle in the plane perpendicular tothe direction of ejecting staples.

A device for checking the conditions of the tissues fastened togetherwith staples driven from the cartridge of a stapler, and a device forelectrically operating the operation section of the stapler will now bedescribed with reference to FIGS. 112, 113, and 114.

FIG. 112 is a diagram illustrating a surgical operation system, whichcomprises an automatic stapler 700, a camera unit 702, a scope such as alaparoscope, and a monitor display 704. The stapler 700 comprises anoperation section 1, an insertion section 2, and a stapling member 5.The member 5 comprises a cartridge 3 and an anvil 4. The operationsection 1 has an operating member 6, a staple-driving handle 7, and aconnecting pin 32.

Pressure sensors 714 (FIG. 113) are arranged in the grooves formed inthe inner surface of the anvil 4. Each sensor 714 detects the pressurewith which the legs a of a staple are pushed onto the bottom of thegroove. Pressure sensors (not shown) are also arranged in thecutter-guiding groove formed in the inner surface of the cartridge 3,for detecting the pressure with which a cutter (not shown) is pressed onthe bottom of the cutter-guiding groove.

The operation section 1 of the automatic stapler 700 is connected by acable 720 to the camera unit 702. The scope 703 is connected to thecamera unit 702 by a cable 721. Further, the monitor display 704 isconnected to the camera unit 702.

The monitor display 704 has a display screen which consists of a mainscreen and a sub-screen. The main screen is used to display the interiorof the body cavity into which the scope 703 will be inserted. Thesub-screen is smaller than the main screen and used to display imagesindicating the condition of the target tissues ligated with staples andthe condition of the tissues severed by the cutter. The images have beenformed by processing the pressures detected by the pressure sensorsdescribed above.

The sub-screen consists of two sections. The first section displaysimages of the staples which can represented in different colors, eachcolor showing the stapled condition of the tissues together. The secondsection displays an image of the cutter-guiding groove which can berepresented in different colors, each color indicating the severedcondition of the stapled tissues.

As is shown in FIG. 114, the camera unit 702 contains an image-formingunit 725 and a superimposing circuit 726. The pressure sensors 714incorporated in the stapler 700 and the pressure sensor located in thecutter-guiding groove are connected to the image-forming unit 725. Theunit 725 processes the data showing the pressures detected by thesensors 714 and the pressure sensor arranged in the cutter-guidinggroove, thereby forming images of the staples and an image of thecutter-guiding groove from. As mentioned above, the color which theimage of each staple assumes indicates the stabled condition of thetissues, and the color which the image of the cutter-guiding grooveassumes represents the severed condition of the tissues.

The image-forming unit 725, the CCD (Charge-Coupled Device) 724incorporated in the scope 703, and the monitor display 704 are connectedto the superimposing circuit 726. The CCD 724 generates datarepresenting the image of the body-cavity interior which the scope 703has scanned. This data is input to the superimposing circuit 726. Thedata which the image-forming unit 725 has generated and which representsthe stapled condition and the tissues and the severed condition thereofis also input to the superimposing circuit 726. The circuit 726processes the input data items, generating image signals. The imagesignals are supplied to the monitor display 704, which displays theimage of the body cavity interior on the main screen, the images of thestaples in the first section of the sub-screen, and the image of thecutter-guiding groove in the second section of the sub-screen.

In the surgical operation system, each pressure sensor 714 located inthe groove formed the anvil 4 detects the pressure bending pushing thelegs of the staple inwardly to each other to fasten the tissuestogether. The data representing the pressures measured by the sensors714 is supplied to the image-forming unit 725. The image-forming unit725 generates data showing the condition in which each staple fastensthe tissues together, and this data is input to the superimposingcircuit 726. The circuit 726 processes the data and the image dataoutput by the scope 703, producing image signals. The image signals areinput to the monitor display 704. The display 704 displays the image ofthe body cavity interior on the main screen, the images of the staplesin the first section of the sub-screen, and the image of thecutter-guiding groove in the second section of the sub-screen.

If a staple is driven and pierces the tissues, with its legs bentappropriately, the sensor 714 detects the pressure the legs has Justexerted to it. This pressure is represented by the color of the image ofthe staple, which is displayed in the first section of the sub-screen ofthe monitor display 704. From the color of the staple image it ispossible to determine the condition of those portions of the tissueswhich are ligated by that staple.

As the cutter is thrust forward along the cutter-guiding groove, cuttingthe stapled tissues, it pushes the pressure sensor located in thecutter-guiding groove. This sensor detects the pressure it receives andgenerates a signal presenting the pressure detected. The signal is inputto the image-forming unit 725, which produces data representing an imageof the cutter-guiding groove in the color corresponding to the pressurethe cutter has exerted on the pressure sensor. The image of the grooveis eventually displayed by the monitor display 704. The color of theimage of the groove, thus displayed, indicates the severed condition ofthe tissues.

Just recognizing the colors in which the images of the staples and thecutter-guiding groove, all displayed on the sub-screen of the monitordisplay 704, a surgeon can determine whether or not the tissues havebeen stapled properly and severed appropriately. If the surgeon findsthat any staple has failed to fasten the tissues in a desirable manner,he or she may operates the stapling member 5 again to make the stapleligate the tissues appropriately. Thus, no staples are left inundesirable state, which prevents the body fluid oozing from the ligatedtissues.

The operating member 6 on the frame of the operation section 2 ismanually operated to open and close the stapling member 5. Instead, themember 5 may be opened an closed by an electric drive unit. FIG. 113shows such an electric drive unit 747 incorporated in the operationsection 1.

As shown in FIG. 113, the electric drive unit 747 comprises a rod 741, atransmission 742, a drive motor 743, and an drive mechanism 727. Thetransmission 742 comprises a worm and a worm wheel. The rod 741 isconnected at its rear end to the worm of the transmission and at itsforward end to an outer tube 9 of the same type as shown in FIGS. 4 and5. The worm wheel is mounted on the shaft of the motor 743. Hence, whenthe motor 743 is rotated, the rod 741 moves along its axis, therebymoving the outer tube 9 back and forth.

As is shown in FIG. 114, the signals output by the pressure sensors 714and the signal output by the pressure sensor located in thecutter-guiding groove are input to a controller 744. From these signalsthe controller 744 generates a control signal, which is supplied to aservo amplifier 745. The amplifier 745 amplifies the control signal. Theamplified signal is supplied to the drive motor 743, driving the motor743. Thus, the motor 743 is controlled by the signals output by thepressure sensors 714 and the signal output by the pressure sensorlocated in the cutter-guiding groove.

Therefore, the body tissues clamped between the cartridge 3 and theanvil 4 can be automatically fastened together, uniformly at any part ofthem. If an excessively high pressure is found to be applied on certainparts of the tissues, for example, the stapling member 5 is opened untilthe pressure decreased to a desirable value, and then a staple is driveninto those part of the tissues. The tissues would not be clamped tootightly at some parts and too loosely at the others, and can thereforebe stapled uniformly.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details, and representative devices shownand described herein. Accordingly, various modifications may be madewithout departing from the spirit or scope of the general inventiveconcept as defined by the appended claims and their equivalents.

What is claimed is:
 1. A surgical device for stapling and fastening bodytissues, comprising:an operation section operated outside a body cavity;an insertion section extending from said operation section for insertioninto a body cavity; high-frequency applying means provided at a distalend portion of said insertion section, for applying a high-frequencywave to body tissues within a body cavity; a cartridge provided at thedistal end portion of the insertion section, said cartridge containing aplurality of staples, the staples each having at least two legs whichare to be inserted into the body tissues; staple-applying means providedat the distal end portion of the insertion section, and coupled to saidcartridge for applying at least one staple from said cartridge to targettissues through said distal end portion of said insertion section;staple-deforming means provided at the distal end portion of theinsertion section for deforming the at least one staple applied to thetarget tissues by said staple-applying means, thereby stapling thetarget tissues together; and current-supplying means, extending throughsaid insertion section from said operation section to saidhigh-frequency applying means, for supplying a high-frequency current tosaid high-frequency applying means to prevent bleeding of treated targettissues, said high-frequency applying means being electrically connectedto the at least one staple applied to the target tissues and applyinghigh-frequency waves to the at least one staple; said cartridge, saidstaple-applying means and said staple-deforming means all beingoperatable by operating said operation section.
 2. The surgical deviceaccording to claim 1, further comprising:a cutter for cutting the targettissues, said cutter being provided at said distal end portion of saidinsertion section; and wherein: said staple-deforming means and saidcartridge are located near said high-frequency applying means in orderto staple the target tissues to be cut by said cutter.
 3. The surgicaldevice according to claim 2, wherein:said cutter comprises anelectrically conductive cutter; and said high-frequency applying meansincludes means for applying a high-frequency wave to said cutter toprevent bleeding due to cutting of the target tissues.
 4. The surgicaldevice according to claim 1, wherein said staple-deforming meanscomprises:first deforming means for deforming a first leg of the atleast one staple; second deforming means for deforming a second leg ofthe at least one staple; and drive means for selectively driving saidfirst and second deforming means.
 5. A surgical device for stapling andfastening body tissues, comprising:an operation section operated outsidea body cavity; an insertion section extending from said operationsection for insertion into a body cavity; high-frequency applying meansprovided at a distal end portion of said insertion section for applyinga high-frequency wave to body tissues within a body cavity; a cartridgeprovided at the distal end portion of the insertion section, saidcartridge containing a plurality of staples, the staples each having atleast two legs which are to be inserted into the body tissues;staple-applying means provided at the distal end portion of theinsertion section, and coupled to said cartridge for applying at leastone staple from said cartridge to target tissues through said distal endportion of said insertion section; staple-deforming means, including ananvil, provided at the distal end portion of the insertion section fordeforming the at least one staple applied to the target tissues by saidstaple-applying means, thereby stapling the target tissues together; andcurrent-supplying mean, extending through said insertion section fromsaid operation section to said high-frequency frequency applying means,for supplying a high-frequency current to said high-frequency applyingmeans to prevent bleeding of treated target tissues, said high-frequencyapplying means being electrically connected to the at least one stapleapplied to the target tissues and applying high-frequency waves to theat least one staple; said cartridge, said staple-applying means and saidstaple-deforming all means being operatable by operating said operationsection; said anvil and said cartridge being rotatably connected to saiddistal end portion of said insertion section and have opposing surfacesbetween which target tissues are held; said staple-applying meansapplying the staples from said cartridge toward said anvil such that thelegs of a staple pierce the target tissues; said anvil and saidcartridge each having a proximal portion extending in a same directionas said insertion section, and a distal portion curving in a planeperpendicular to a direction of applying the staple; an electricallyconductive cutter for cutting the target tissues, said cutter beingprovided at said distal end portion of said insertion section; saidstaple-deforming means and said cartridge being located near saidhigh-frequency applying means in order to staple the target tissues tobe cut by said cutting; and said high-frequency applying means includesmeans for applying a high-frequency wave to said cutter to preventbleeding due to cutting of the target tissues.
 6. The surgical deviceaccording to claim 5, wherein said cutter comprises:a cutter guideformed in the opposing surfaces of said anvil and cartridge and curvingalong the lengths of the distal portions of said anvil and cartridge;and drive means for moving said cutter along said cutter guide.
 7. Thesurgical device according to claim 6, wherein:said staple-applying meanscomprises a plurality of holes formed in the opposing surface of saidcartridge, through which to apply the staples, said holes being arrangedon both sides of said cutter guide; and said staple deforming meanscomprises a plurality of grooves formed in the opposing surface of saidanvil, said grooves opposing said holes of said staple-applying means.8. The surgical device according to claim 6, wherein said operationsection comprises:a connecting section for connecting saidcurrent-supplying means to a high frequency cautery device; an operatingsection for opening and closing said anvil and said cartridge; and adrive section for driving said cutter and said staple-applying means. 9.The surgical device according to claim 6, wherein said drive means andsaid staple-applying means each respectively include flexible portionswhich are bendable along the cutter guide.
 10. A surgical device forstapling and fastening body tissues, comprising:an operation sectionoperated outside a body cavity; an insertion section extending from saidoperation section for insertion into a body cavity; high-frequencyapplying means provided at a distal end portion of said insertionsection, for applying a high-frequency wave to body tissues within abody cavity; a cartridge provided at the distal end portion of theinsertion section, said cartridge containing a plurality of staples, thestaples each having at least two legs which are to be inserted into thebody tissues; staple-applying means provided at the distal end portionof the insertion section, and coupled to said cartridge for applying atleast one staple from said cartridge to target tissues through saiddistal end portion of said insertion section; staple-deforming meansprovided at the distal end portion of the insertion section fordeforming the at least one staple applied to the target tissues by saidstaple-applying means, thereby stapling the target tissues together; andcurrent-supplying means, extending through said insertion section fromsaid operation section to said high-frequency applying means, forsupplying a high-frequency current to said high-frequency, applyingmeans to prevent bleeding of treated target tissues; said cartridge,said staple-applying means and said staple-deforming all means beingoperatable by operating said operation section; and wherein:said distalend portion of said insertion section has an end face; saidstaple-applying means is formed in said end face and has astaple-applying opening; and said high-frequency applying meanscomprises a member projecting from said end face for supplying thehigh-frequency current to the target tissues when set in contact withthe target tissues and for moving the target tissues in the direction ofapplying the staples.
 11. The surgical device according to claim 10,wherein said insertion section comprises:a rigid distal end portion; arigid proximal portion; a coupling section connecting said rigid distalend portion rotatably to said rigid proximal portion; and a drivesection for rotating said rigid distal end portion.
 12. The surgicaldevice according to claim 10, wherein said high-frequency applying meansis electrically connected to the at least one staple applied to thetarget tissues, and applies high-frequency waves to the at least onestaple.
 13. A surgical device for stapling and fastening body tissues,comprising:an operation section operated outside a body cavity; aninsertion section extending from said operation section for insertioninto a body cavity; high-frequency applying means provided at a distalend portion of said insertion section for applying a high-frequency waveto body tissues within a body cavity; a cartridge provided at the distalend portion of the insertion section, said cartridge containing aplurality of staples, the staples each having at least two legs whichare to be inserted into the body tissues; staple-applying means providedat the distal end portion of the insertion section, and coupled to saidcartridge for applying at least one staple from said cartridge to targettissues through said distal end portion of said insertion section;staple-deforming means provided at the distal end portion of theinsertion section for deforming the at least one staple applied to thetarget tissues by said staple-applying means, thereby stapling thetarget tissues together; and current-supplying means, extending throughsaid insertion section from said operation section to saidhigh-frequency applying means, for supplying a high-frequency current tosaid high-frequency applying means to prevent bleeding of treated targettissues; said cartridge, said staple-applying means and saidstaple-deforming all means being operatable by operating said operationsection; and wherein:the distal portion of said insertion section has anend face, a staple-applying opening formed in said end face, and astaple-applying section for applying a staple to the target tissues; andthe device further comprises a member projecting from said end face formoving the target tissues in the direction of applying the staples, whenset in contact with the target tissues.
 14. The surgical deviceaccording to claim 13, wherein said high-frequency applying means iselectrically connected to the at least one staple applied to the targettissues, and applies high-frequency waves to the at least one staple.15. The surgical device according to claim 13, wherein saidhigh-frequency applying means is electrically connected to the at leastone staple applied to the target tissues, and applies high-frequencywaves to the at least one staple.
 16. A surgical device for stapling andfastening body tissues, comprising:an operation section operated outsidea body cavity; an insertion section extending from said operationsection for insertion into a body cavity; high-frequency applying meansprovided at a distal end portion of said insertion section, for applyinga high-frequency wave to body tissues within a body cavity; a cartridgeprovided at the distal end portion of the insertion section, saidcartridge containing a plurality of staples, the staples each having atleast two legs which are to be inserted into the body tissues;staple-applying means provided at the distal end portion of theinsertion section, and coupled to said cartridge for applying at leastone staple from said cartridge to target tissues through said distal endportion of said insertion section; staple-deforming means provided atthe distal end portion of the insertion section for deforming the atleast one staple applied to the target tissues by said staple-applyingmeans, thereby stapling the target tissues together; current-supplyingmeans, extending through said insertion section from said operationsection to said high-frequency applying means, for supplying ahigh-frequency current to said high-frequency applying means to preventbleeding of treated target tissues; said cartridge, said staple-applyingmeans and said staple-deforming all means being operatable by operatingsaid operation section; a cutter for cutting the target tissues, saidcutter being provided at said distal end portion of said insertionsection; said staple-deforming means and said cartridge being locatednear said high-frequency applying means in order to staple the targettissues to be cut by said cutter; and tying means, mounted at saiddistal end portion of said insertion section, for applying a tyingthread to the target tissues cut by said cutter, along cut edges of thetarget tissues; said tying means including means for passing a thread ina zigzag fashion into an edge of the target tissues, which are to be cutby the cutter, and for pulling the thread to contract the eden of thetarget tissues.